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Updated: Oct 21, 2025
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals
Jennifer A Belsky1,2, Sandeep Batra1,2, Joseph R Stanek3
1Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Constipation in children with acute lymphoblastic leukemia (ALL) during induction chemotherapy is linked to increased hospital stays, mucositis, and healthcare use. Early constipation management is crucial for these young patients.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Hematology
Background:
- Children with acute lymphoblastic leukemia (ALL) experience numerous chemotherapy side effects.
- Constipation is a common issue, often linked to vinca alkaloids, psychological stress, and opioid use.
- This study examines the morbidity of constipation in hospitalized children with ALL during induction therapy.
Purpose of the Study:
- To investigate the morbidity associated with constipation in hospitalized children with ALL receiving induction chemotherapy.
- To assess the impact of constipation on infections, mucositis, and healthcare utilization.
- To identify potential areas for improved management strategies.
Main Methods:
- Analysis of data from 48 children's hospitals (Pediatric Health Information System).
- Inclusion of patients aged 1-21 years with ALL hospitalized for induction (Oct 2015 - Dec 2019).
- Nonparametric statistical analysis and calculation of adjusted odds ratios (aOR) for outcome comparisons.
Main Results:
- 56% of 4622 ALL patients experienced constipation during induction.
- Constipation significantly increased the likelihood of mucositis (aOR=2.30), perirectal issues (aOR=3.21), and abdominal radiograph use (aOR=2.40).
- Median induction hospitalization was longer for patients with constipation (10 days vs. 8 days).
Conclusions:
- Constipation in pediatric ALL patients during induction is associated with longer hospital stays, mucositis, imaging use, and higher healthcare utilization.
- Further research is needed to explore the causal link between constipation and infections.
- Enhanced constipation management is recommended for ALL patients starting induction therapy, especially those with complications or prolonged hospitalizations.
Background:
Childrenwith acute lymphoblastic leukemia (ALL) suffer a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, psychological stressors, and opioid use are common issues for children newly diagnosed with leukemia. This study investigated the morbidity associated with constipation including infections, mucositis, and healthcare utilization in hospitalized children with ALL receiving induction chemotherapy.
Methods:
We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL, hospitalized for induction from October 2015 through December 2019. Data were analyzed using nonparametric statistics, and comparisons of outcomes between those with and without constipation were presented as adjusted odds ratios (aOR).
Results:
We identified 2586 (56%) patients with constipation out of a total of 4622 unique ALL patients in induction. Compared to patients without constipation during induction, patients with constipation were significantly more likely to have mucositis (aOR = 2.30; p = 0.0010), perirectal issues (aOR = 3.21; p = 0.0092), or abdominal radiograph exposure (aOR = 2.40; p < 0.0001). The median length of induction hospitalization was significantly greater in those with constipation compared to those without constipation (10 days vs. 8 days; p < 0.0001).
Conclusions:
Children with ALL suffering from constipation during induction therapy have increased length of stay, mucositis, imaging, and overall healthcare utilization compared to children without constipation. Further research should explore the causative relationship between constipation and infections. Increased attention should be given to constipation management in patients with ALL at the start of induction therapy, particularly in patients with complications or prolonged hospitalizations.
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