Alteration in Bone Mineral Metabolism in Children with Acute Lymphoblastic Leukemia (ALL): A Review

In recent years there has been a significant increase in event free survival (EFS) and overall survival in children with cancer. As survival rates for childhood cancer have radically improved, late effects associated with the successful but highly intensive chemotherapy and/or radiotherapy have dramatically increased. Many possible late effects of cancer treatment are recognized in pediatric cancer patients as infertility, endocrine deficiency, renal failure, pulmonary and cardiac toxicity, obesity and osteopenia/osteoporosis. Decreased bone mineral density (BMD) and bone metabolism disturbances have been recognized and reported in literature. Osteopenia/osteoporosis skeletal abnormalities, osteonecrosis and pathological fractures are known to occur frequently in childhood acute lymphoblastic leukemia (ALL) at diagnosis, during and after treatment with chemotherapy. Various studies have revealed different metabolic alterations related to ALL. Some suggestions have been made about their relationship with the disease process. Various metabolic abnormalities may be encountered in the newly diagnosed ALL patients. It includes decreased and increased serum levels of calcium and phosphate. Hypercalcemia may result from leukemic infiltrations of bone and release of parathormone like substance from lymphoblast. Elevated serum phosphate can occur as a result of leukemic cell lysis and may induce hypocalcemia. It has been postulated by other authors that leukemic cells may directly infiltrate bone and produce parathroid hormone related peptides, prostaglandin E and osteoblast inhibiting factors. Hypomagnesemia, hypocalcaemia and hypothyroidisum have been demonstrated in patients with ALL. Some patients may have poor nutrition and decreased physical activities during treatment. However postulations have also been made that chemotherapy may play a role in creating metabolic alterations in children with ALL. Corticosteroid, methotraxate and cranial irradiations have all been assumed as a cause of loss of bone mass. Continuing chemotherapy in children with ALL was assumed with normal growth and normal or high collagen turnover and reduced alkaline phosphatase or impaired osteoblastic activity on mineralization of bone. Considering the derangements in bone mineral metabolism in ALL at diagnosis or with chemotherapy, it is imperative that specific attention and therapeutic measures should be considered.DOI: 10.3329/bsmmuj.v1i1.3695 BSMMU J 2008; 1(1): 29-3

Change of lipid profile in children with acute lymphoblastic leukemia due to induction chemotherapy in a tertiary care hospital of Bangladesh

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. In the Department of Paediatric Haematology and Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), 58% of ALL cases were recorded among 455 newly diagnosed malignancy patients in a single year. Studies found that remarkable hypertriglyceridemia occurs with L-asparaginase therapy and steroid. This study was done to evaluate the changes of serum total cholesterol, triglycerides (TG), high density lipoprotein (HDL), and low-density lipoprotein (LDL) during and after induction chemotherapy in children with ALL. Methods: This prospective observational study was performed in the Department of Pediatric Hematology and Oncology of BSMMU from March-November 2013. Newly diagnosed acute lymphoblastic leukemia patients aged 3-15 years were included in this study after having written consent from the parents of the participants to participate in the study and enrolled for the treatment of ALL (according to modified UKALL 2003 protocol). Results: Total cholesterol, TG, HDL, and LDL changed significantly due to induction therapy. Serum total cholesterol and LDL decreased after completion of L-asparaginse in comparison to before induction, increased significantly after completion of induction in comparison to after completion of L-asparaginase (P=0.001), and increased significantly after induction in relation to before induction therapy (P=0.003). TG decreased significantly (P=0.033) after completion of L-asparaginase than before induction but increased after completion of induction. HDL increased after completion of L-asparaginase and after induction significantly (P=0.001). LDL decreased after completion of L asparaginase which was significant (P=0.005). Conclusion: After induction chemotherapy, total cholesterol, HDL and LDL level increased and TG level decreased among ALL patients. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 35-40

Change of lipid profile in children with acute lymphoblastic leukemia due to induction chemotherapy in a tertiary care hospital of Bangladesh

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. In the Department of Paediatric Haematology and Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), 58% of ALL cases were recorded among 455 newly diagnosed malignancy patients in a single year. Studies found that remarkable hypertriglyceridemia occurs with L-asparaginase therapy and steroid. This study was done to evaluate the changes of serum total cholesterol, triglycerides (TG), high density lipoprotein (HDL), and low-density lipoprotein (LDL) during and after induction chemotherapy in children with ALL. Methods: This prospective observational study was performed in the Department of Pediatric Hematology and Oncology of BSMMU from March-November 2013. Newly diagnosed acute lymphoblastic leukemia patients aged 3-15 years were included in this study after having written consent from the parents of the participants to participate in the study and enrolled for the treatment of ALL (according to modified UKALL 2003 protocol). Results: Total cholesterol, TG, HDL, and LDL changed significantly due to induction therapy. Serum total cholesterol and LDL decreased after completion of L-asparaginse in comparison to before induction, increased significantly after completion of induction in comparison to after completion of L-asparaginase (P=0.001), and increased significantly after induction in relation to before induction therapy (P=0.003). TG decreased significantly (P=0.033) after completion of L-asparaginase than before induction but increased after completion of induction. HDL increased after completion of L-asparaginase and after induction significantly (P=0.001). LDL decreased after completion of L asparaginase which was significant (P=0.005). Conclusion: After induction chemotherapy, total cholesterol, HDL and LDL level increased and TG level decreased among ALL patients. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 35-40

Vincristine induced peripheral neuropathy in children undergoing chemotherapy for acute lymphoblastic leukaemia during induction

Background: Vincristine is an anticancer agent administered to all children with acute lymphoblastic leukemia (ALL), and peripheral neuropathy is the major dose-limiting toxicity of this therapy. As cure rates of childhood ALL exceeds 80%, therefore treatment-related toxicities need to be reduced. Thus, the aim of this study was to determine the prevalence and risk factors of vincristine-induced peripheral neuropathy (VIPN) in children with ALL undergoing induction chemotherapy. Methods: A case-control study was conducted from September 2017 to August 2018 in the Department of Paediatric Haematology and Oncology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Eighty newly diagnosed ALL and 35 acute myeloid leukemia (AML) cases aged 5 to 17 years with no pre-existing neurological abnormality were recruited. To assess the peripheral neuropathy, we used pediatric-modified total neuropathy score and National Cancer Institute- Common Terminology Criteria for Adverse Events (NCI-CTCAE), version-04 grade. Results: Among ALL patients, 29.2% developed peripheral neuropathy compared to 10% in AML control group (P=0.04). Higher proportion (57.1%) of peripheral neuropathy was found in age below 10 years (P<0.001). There was no significant association of peripheral neuropathy with sex and body mass index of the patients. Conclusion: Almost 3 in 10 patients developed VIPN during the induction therapy which is significantly higher in age below 10 years compared to ≥ 10 years.   Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 02-07

Vincristine induced peripheral neuropathy in children undergoing chemotherapy for acute lymphoblastic leukaemia during induction

Background: Vincristine is an anticancer agent administered to all children with acute lymphoblastic leukemia (ALL), and peripheral neuropathy is the major dose-limiting toxicity of this therapy. As cure rates of childhood ALL exceeds 80%, therefore treatment-related toxicities need to be reduced. Thus, the aim of this study was to determine the prevalence and risk factors of vincristine-induced peripheral neuropathy (VIPN) in children with ALL undergoing induction chemotherapy. Methods: A case-control study was conducted from September 2017 to August 2018 in the Department of Paediatric Haematology and Oncology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Eighty newly diagnosed ALL and 35 acute myeloid leukemia (AML) cases aged 5 to 17 years with no pre-existing neurological abnormality were recruited. To assess the peripheral neuropathy, we used pediatric-modified total neuropathy score and National Cancer Institute- Common Terminology Criteria for Adverse Events (NCI-CTCAE), version-04 grade. Results: Among ALL patients, 29.2% developed peripheral neuropathy compared to 10% in AML control group (P=0.04). Higher proportion (57.1%) of peripheral neuropathy was found in age below 10 years (P<0.001). There was no significant association of peripheral neuropathy with sex and body mass index of the patients. Conclusion: Almost 3 in 10 patients developed VIPN during the induction therapy which is significantly higher in age below 10 years compared to ≥ 10 years.   Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 02-07

A 2-year-old male child with diffuse abdominal pain, mass in the abdomen and red currant jelly stool

This article has no abstract. The first 100 words appear below: A 2-year-old male child, the second issue of non-consanguineous parents, from average socio-economic status hailing from Dinajpur, Bangladesh was attended at Pediatric Surgery outpatient department with the complaints of vague diffuse abdominal pain in the lower right side of abdomen and around the umbilical region for last 3 days. His mother also reported the feeling of a solid mass in the abdomen during dressing of her child. Then, gradually his problems were increasing in nature with several times of nausea, vomiting, and the passage of blood mixed stool three times before his admission

Increasing role of cytogenetics in the diagnosis and stratification of childhood leukaemia

No abstract available

Outcome of neutropenic enteropathy during induction phase of treatment of childhood acute lymphoblastic leukemia

Background: Neutropenic enteropathy is one of the important causes of death during intensive phase of chemotherapy in children with acute lymphoblastic leukemia (ALL). It follows a prolonged course of neutropenia and carries a mortality rate up to 30%. The study aimed to find out the outcomes of typhlitis during induction phase of treatment of childhood ALL. Material and methods: This prospective case control study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2018 to January 2021. Children (<19 years) with ALL who developed neutropenic enteropathy during induction phase of chemotherapy without any comorbid condition were included in this study. The clinico-radiological diagnosis of neutropenic enteropathy was based on a standard diagnostic criteria. Complete blood count, serum electrolytes, albumin, blood culture, stool culture, abdominal X-ray and ultrasonogram were performed in all the cases. Results: Thirty-six patients developed neutropenic enteropathy. 8 (22.2%) died. Thrombocytopenia (p = 0.001), hypoalbuminemia (Odd ratio 21.0, p < 0.001), positive blood culture (Odd ratio 6.11, p = 0.026). Conclusion: This study found a mortality rate of 22.2% amongst the pediatric patients with ALL who developed neutropenic enteropathy during induction chemotherapy. Thrombocytopenia, hypoalbuminemia, and a positive blood culture predicted mortality