Çocukluk Çağı Akut Myeloid Lösemilerde Kan Ürünü Kullanımının Kemoterapi Bloklarına Göre Dağılımı

Abstract

Amaç: Bu çalışmada; akut myeloblastik lösemi (AML) tanısı ile kemoterapi blokları alan çocuk hastalara verilmiş olan toplam eritrosit, random trombosit ve aferez trombosit süspansiyonun, hastanın o dönemde almış olduğu kemoterapi (KT) bloğu ile olan ilişkisi değerlendirilmiştir.

Gereç ve Yöntemler: AML tanısı ile takip edilen toplam 146 hastanın transfüzyon ihtiyacı, hastaların kan bankası verilerine girilerek tedavi  süresince,  torba sayısı ve tipi olarak eritrosit, random trombosit ve trombosit süspansiyonu olarak belirlendi.

Bulgular: Toplam 37 hastanın tanı konulduğu andan tedavinin bittiği döneme kadarki süreçte hasta başı ortalama toplam eritrosit kullanımı 27 (10-102) adetti. KT blokları esnasında hem eritrosit hem de aferez trombosit kullanımının en fazla olduğu blok Aie bloğu idi. Bu blokta ki ortalama kişi başı eritrosit kullanımı  8 (2-20) adet iken, aferez trombosit kullanımı 8,5 (1-28) adet olarak saptanmıştır. Random trombosit kullanım adeti ise kişi başı ortalama 20 (7-139) adet iken, en fazla random trombosit kullanılan KT bloğu olan İdame’de ki ortalama kişi başı random trombosit kullanım adeti 27 (1-102) olarak saptanmıştır.

Sonuç: AML’li çocuklarda KT süresince çok sayıda kan ve kan ürünü transfüzyonu gereklidir. Bu transfüzyonun etkinliği akut löseminin tipine, hastanın yaşına, cinsiyetine, hastanın aldığı KT bloğu ile o dönem aldığı KT ilaçlarına ya da hastanın o dönemde ki enfeksiyon, sepsis, yaygın tüketim koagulopatisi gibi klinik bir tabloda olup olmaması gibi çok sayıda etkene bağlı olabilir.

Keywords

• Akut myeloblastik lösemi
• Çocuk
• Kemoterapi
• Transfüzyon

Blood Product Requirement in Childhood Acute Myeloid Leukemia by Chemotherapy Regimens

Abstract

Aim: This study evaluates the association of total erythrocyte, random platelet and apheresis platelet suspension given to children receiving chemotherapy (CT) blocks with a diagnosis of acute myeloblastic leukemia (AML) with the chemotherapy (CT) block the patient received in that period.

Material and Methods: The transfusion need of a total of 146 patients followed with a diagnosis of AML were determined as erythrocyte, random platelet and platelet suspension as number and type in bags from the moment the patients were diagnosed to the period the treatment ended by entering the blood bank data base records.

Results: The number of total per patient average erythrocyte use of a total of 37 patients during the process from the moment they were diagnosed to the period the treatment ended was 27 (100-102). Of the CT blocks, the block in which both erythrocyte and apheresis platelet use was the highest was Aie block. While the average per person erythrocyte use was 8 (2-20) in this block, apheresis platelet use was found as 8,5 (1-28). While the number of average per person random platelet use was 20 (7-139), the number of average per person random platelet use was as 27 (1-102) in the Maintenance block, which is the CT block in which the most random platelet was used.

Conclusion: In children with AML, a great number of blood and blood product transfusions are needed during CT. The efficiency of these transfusions can depend on a great number of factors such as the type of acute leukemia, patient age, patient gender, the CT block the patient is receiving, the CT drugs the patient is receiving in that period and whether the patient has a clinical picture such as infection, sepsis, intense consumption coagulopathy during that period. 

Keywords

• Acute myeloblastic leukemia
• child
• chemotherapy
• Transfusion
• Blood

References

1. REFERENCES:1. Golub TRA, R.J. Acute myelogenous leukemia. In: DG PPaP, editor. Principles and Practice of Pediatric Oncology. 4 ed. Philadelphia: Lippincott Williams and Wilkins Company; 2002. p. 545-89.2. Heckman KD, Weiner GJ, Davis CS, Strauss RG, Jones MP, Burns CP. Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL. J Clin Oncol. 1997;15:1143-9 DOI: 10.1200/JCO.1997.15.3.1143.3. Rebulla P, Finazzi G, Marangoni F, Avvisati G, Gugliotta L, Tognoni G, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med. 1997;337:1870-5 DOI: 10.1056/NEJM199712253372602.4. Schiffer CA, Anderson KC, Bennett CL, Bernstein S, Elting LS, Goldsmith M, et al. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1519-38 DOI: 10.1200/JCO.2001.19.5.1519.5. Wandt H, Frank M, Ehninger G, Schneider C, Brack N, Daoud A, et al. Safety and cost effectiveness of a 10 x 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 x 10(9)/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood. 1998;91:3601-6.6. Zumberg MS, del Rosario ML, Nejame CF, Pollock BH, Garzarella L, Kao KJ, et al. A prospective randomized trial of prophylactic platelet transfusion and bleeding incidence in hematopoietic stem cell transplant recipients: 10,000/L versus 20,000/microL trigger. Biol Blood Marrow Transplant. 2002;8:569-76.7. Margolin JF SC, Poplack DG. Acute Lymphoblastic Leukemia. In: DG PPaP, editor. Principles and Practiceof Pediatric Oncology. 4 ed: Lippincott Williams & Wilkins; 2002. p. 489-544.8. Campana D, Behm FG. Immunophenotyping of leukemia. J Immunol Methods. 2000;243:59-75.9. Belson M, Kingsley B, Holmes A. Risk factors for acute leukemia in children: a review. Environ Health Perspect. 2007;115:138-45 DOI: 10.1289/ehp.9023.10. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000;50:7-33.11. Lanzkowsky P. Manuel of Pediatric Hematology and Oncology. 5 ed. New York: Elsevier; 2011.12. Webb DK, Harrison G, Stevens RF, Gibson BG, Hann IM, Wheatley K, et al. Relationships between age at diagnosis, clinical features, and outcome of therapy in children treated in the Medical Research Council AML 10 and 12 trials for acute myeloid leukemia. Blood. 2001;98:1714-20.13. Kutanis A. Çocukluk Çagı Akut Lösemi Vakalarının Retrospectif Degerlendirilmesi. İstanbul2005.14. Günes AM. Türkiyede uygulanan AML sagaltım protokolleri ve sonuçları. 6 Ulusal Hematoloji Kongresi 2007. p. 96-9.15. Apak H. Türkiyede uygulanan AML sağaltım protokolleri ve sonuçları: BFM AML sağaltım protokolleri. 6 Ulusal Hematoloji Kongresi2007. p. 92-5.16. Gaynon PS, Trigg ME, Heerema NA, Sensel MG, Sather HN, Hammond GD, et al. Children's Cancer Group trials in childhood acute lymphoblastic leukemia: 1983-1995. Leukemia. 2000;14:2223-33.17. Ribeiro RC, Razzouk BI, Pounds S, Hijiya N, Pui CH, Rubnitz JE. Successive clinical trials for childhood acute myeloid leukemia at St Jude Children's Research Hospital, from 1980 to 2000. Leukemia. 2005;19:2125-9 DOI: 10.1038/sj.leu.2403872.