SERUM FERRITIN CONTENT AND INCIDENCE AND TYPE OF INFECTIOUS AND INFLAMMATORY COMPLICATIONS IN CHILDREN WITH ACUTE
D A Bazyka1, V A Zhovnir1, K M Bruslova1
1State Institution «National Research Center for Radiation Medicine, Hematology and Oncology of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine.
Insights
High serum ferritin (SF) levels in children with acute lymphoblastic leukemia (ALL) correlate with increased infectious complications and mortality. Early diagnosis and preventive measures for iron overload are crucial for improving outcomes in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Environmental Medicine
Background:
- Children residing in radiologically contaminated territories (RCT) after the ChNPP accident are at increased risk.
- Acute lymphoblastic leukemia (ALL) is a significant pediatric cancer requiring comprehensive management.
- Serum ferritin (SF) levels may indicate iron overload and influence disease progression and complications.
Purpose of the Study:
- To evaluate the frequency and types of bacterial and fungal complications in pediatric ALL patients from RCT.
- To assess the impact of serum ferritin (SF) levels on the outcomes of pediatric ALL.
- To analyze the relationship between SF content, infectious complications, and mortality in pediatric ALL.
Main Methods:
- A 15-year survey of 146 pediatric ALL patients residing in RCT of Ukraine.
- ALL diagnosis and classification based on FAB criteria and immunophenotyping.
- Assessment of infectious, fungal, and toxic complications, and mortality rates, correlated with SF levels.
- Statistical analysis including Student's t-test, Spearman's correlation, and Chi-squared test.
Main Results:
- Increased SF levels (above 200 ng/ml) were associated with higher incidence of sepsis and anal area infections.
- SF levels above 500 ng/ml correlated with complicated pneumonia and increased systemic toxic effects post-chemotherapy.
- Mortality rates nearly doubled in children with SF levels above 500 ng/ml, particularly in pro-B ALL and T-ALL variants.
- Iron overload was linked to poorer outcomes in common ALL and T-ALL subtypes.
Conclusions:
- Elevated serum ferritin (iron excess) significantly impacts the incidence and type of infectious complications in pediatric ALL.
- Iron overload adversely affects the outcome of ALL in children, necessitating timely diagnosis and intervention.
- Preventive strategies targeting iron overload are essential for improving the management and prognosis of pediatric ALL.
Objective:
evaluation of the frequency and type of bacterial fungal complications and outcome of acute lymphoblastic leukemia (ALL) taking into account the serum ferritin content in children, residing in radiologically contaminated territories (RCT) of Ukraine after the ChNPP accident.
Materials And Methods:
Pediatric ALL patients (n = 146), residing in RCT of Ukraine, were the study subjects within a survey period of 15 years. The ALL diagnosis and distribution of patients by the disease variants were heldaccording to the FAB classification and results of immunophenotyping of the bone marrow blast cells. Chemotherapy(CT) was prescribed according to the BerlinFrankfurtMunster group (BFM) protocols. Patients were examined afterthe remission induction therapy. Incidence and type of the bacterial fungal and toxic complications were assessed.The number of deaths was taken into account depending on the age, ALL variant and serum ferritin (SF) content.Radiation doses to the bone marrow were calculated for the entire period of stay in RCT after the accident.Processing of the obtained materials was carried out using the mathematical statistical methods (Student's andSpearman's correlation coefficients, χ2 Pearson test).
Results:
Study subjects were distributed according to the ALL variants, namely proB (n = 21, 14.4 %), «general»type (n = 97, 66.4 %), preB (n = 12, 8.2 %), and TALL (n = 16, 11.0 %). Three groups were formed taking intoaccount the SF levels: Group I (n = 53) - SF up to 200 ng/ml, Group II (n = 49) - SF from 200 ng/ml to 500 ng/ml,Group III (n = 44) - SF above 500 ng/ml. The blood hemoglobin level and RBC count were decreased along theincrease in SF content (p < 0.05). A direct correlation was found between the SF content and RBC average volume(r = 0.45; р < 0.05). Anemia was of a normocytic type. The lowest number of cases with iron overload was among thechildren with preBHLL disease variant (1 out of 12). An inverse correlation was established between the transferrin concentration and average hemoglobin content in RBC (r = 0.6; р < 0.05). Sepsis and infections of the anal areawere more often observed in the patients with SF level above 200 ng/ml. The course of pneumonia was complicated in case of SF level above 500 ng/ml. The oral cavity and intestinal mucositis did not depend on SF level.Incidence of the systemic toxic effects after chemotherapy was increased under SF level above 500 ng/ml. The number of deaths in children with SF levels above 500 ng/ml was almost doubled. Most of the deaths occurred in thepatients with proBALL (15 out of 21) and TALL (8 out of 16) disease variants. Fewer children had died having the«common» ALL type (14 out of 97, 14.4 %). The number of deaths in case of preBALL variant not depended on SF levels. The «common» type and TALL patients having got iron overload died more often. The average radiationdoses to the bone marrow were (4.9 ± 0.4) mSv and did not affect the remaining parameters.
Conclusions:
Iron excess in the body affects the incidence and type of infectious complications both with the outcome of ALL in children, which requires timely diagnosis and preventive measures.
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