The use of biomarkers in detecting subclinical cardiotoxicity in doxorubicin-based treatment for paediatric patients with acute lymphoblastic leukaemia

The international standard protocol for acute lymphoblastic leukaemia (ALL), the most common haemato-oncological pathology at paediatric age, uses anthracyclines as antitumor agents, potentially associated with early or late onset cardiac damage. Currently, echocardiography is the gold standard in the diagnosis of cardiotoxicity, but several biomarkers are evaluated as a possible replacement, pending more extensive clinical studies. We started a prospective study in order to determine the role of two biomarkers, troponin and heart-type fatty acid binding protein, in the evaluation of cardiotoxicity in children over one year of age, diagnosed with ALL. Between February 2015 and April 2016, 20 patients were enrolled and monitored at diagnosis, during chemotherapy and four months after the end of reinduction, through cardiac evaluation and dosing of those two markers in five different points of the treatment protocol. During the first year of follow-up, the patients did not develop clinical signs of cardiac damage, but the study showed a slight increase in troponin levels during chemotherapy, with the return to baseline value after treatment cessation, and also a correlation with the total dose of anthracyclines given to the patient. On the other hand, the second biomarker, heart-type fatty acid binding protein, did not seem to be useful in detecting subclinical cardiac damage in these patients

2014-2017 RETROSPECTIVE STUDY ON THE ANALYSIS OF CAUSES OF DEATH, OTHER THAN DISEASE PROGRESSION, IN CHILDREN DIAGNOSED WITH ACUTE LYMPHOBLASTIC LEUKAEMIA – EXPERIENCE OF THE PAEDIATRIC DEPARTMENT OF FUNDENI CLINICAL INSTITUTE

Introduction. Acute lymphoblastic leukemia (ALL) is the most common form of cancer in the pediatric population (1). The survival rate has increased in recent years due to the continuous adjustment of therapeutic protocols (2). Despite all the efforts made alongside the evolution of new therapeutic protocols, the treatment related mortality (TRM) is around 2-4% in the Western European countries (3,4). Materials and methods. This retrospective is an analytical, observational and cohort-type study, the first of this kind in Romania, performed in a single pediatric hematology center, Clinical Institute Fundeni, between 2014 and 2017. It assesses the incidence of global mortality, the incidence of mortality due to any cause other than progression of disease (NRM = Non Relapse Mortality) and the main cause of death in children diagnosed with ALL. Results. We included 142 patients diagnosed between January 2014 and June 2017, with follow-up of 48 months post-diagnosis. The overall mortality of the cohort is 10.5% (15/142). The mortality rate for any other cause except disease progression (NRM) is 7.04% (10/15). These ten patients, in molecular remission, have as main cause of death complications that occurred during treatment (TRM= treatment related mortality with / without IRM = infection related mortality). The study showed increased percentages of IRM 6.3%, over value of other studies, explaining and increasing also the value of NRM and also the value of global mortality; In contrast to TRM 2.1%, this being in the reference range (12,17,19,20). The most common cause of NRM was Clostridium difficile infection (4/10). Conclusion. There are important to note the high percentage of achievement of complete remission (98%) and impressive global survival at 4 years (89.4%)

STUDIU RETROSPECTIV 2014-2017, PRIVIND ANALIZA CAUZELOR DE DECES, ALTELE DECÂT PROGRESIA BOLII, LA COPIII DIAGNOSTICAŢI CU LEUCEMIE ACUTĂ LIMFOBLASTICĂ – EXPERIENŢA CLINICII DE PEDIATRIE IC FUNDENI

Introducere. Leucemia acută limfoblastică (LAL) este cea mai frecventă formă de cancer în populaţia pediatrică (1). Datorită ajustării continue a protocoalelor terapeutice, rata de supravieţuire a crescut în ultimii ani (2). În ciuda tuturor eforturilor depuse, rata mortalităţii date de complicaţii (TRM = treatment related mortality) se situează în jur de 2-4% în ţările vest-europene (3,4). Materiale şi metode. Studiul este unul analitic, observaţional, retrospectiv, de tip cohortă, primul de acest tip în Romania, efectuat într-un singur centru hematologic pediatric, Clinica IC Fundeni, în perioada 2014-2017. Acesta evaluează incidenţa mortalităţii globale, incidenţa mortalităţii date de orice cauză, alta decât progresia bolii (NRM = Non Relapse Mortality) şi principala cauză a decesului la copii diagnosticaţi cu LAL. Rezultate. Am inclus 142 pacienţi diagnosticaţi în perioada ianuarie 2014-iunie 2017, cu monitorizare pe parcursul a 48 de luni post diagnostic. Mortalitatea globală a cohortei este 10,5% (15/142). Rata mortalităţii data de NRM este 7,04% (10/15). Aceşti 10 pacienţi aflaţi în remisiune moleculară au drept principală cauză a decesului infecţia precipitată de complicaţiile apărute pe parcursul tratamentului (TRM = treatment related mortality cu/fără IRM = infection related mortality). Studiul a evidenţiat procente crescute de IRM, 6,3%, peste valoarea decelată de alte studii, ceea ce explică şi creşterea valorii de NRM şi cea a mortalităţii globale, în contrast cu valorile TRM 2,1%, aceasta fiind în intervalul de referinţă (12,17,19,20). Cea mai frecventă cauză de NRM a fost infecţia cu Clostridium difficile (4/10). Concluzie. Sunt importante de reţinut procentul mare de obţinere a remisiunii complete (98%) şi supravieţuirea globală impresionantă la 4 ani (89,4%)