Evaluation of clinical neurological complications and prognosis in children with acute lymphoblastic leukemia

Yıl 2023, Cilt: 28 Sayı: 2, 149 - 158, 23.05.2023

Özlem Kalaycık Şengül , Aylin Canbolat , Çetin Timur , Elif Karatoprak , Müferet Ergüven

https://doi.org/10.21673/anadoluklin.1201526

Öz

Aim: The aim of the present study is to evaluate the neurological complications, which occur during the treatment process, to determine the risk factors of these complications and their impact on children with acute lymphoblastic leukemia.

Methods: In our study, patients who were younger than 18 years of age with the diagnosis of acute lymphoblastic leukemia and who were treated with Berlin Frankfurt Munster (BFM) TR ALL-2000 chemotherapy protocol between January 2006 and December 2011 were retrospectively retrieved from our medical records. A total number of 200 patients were included in the study and 6 of them were excluded due to central nervous system involvement when diagnosed. Demographic, clinical, radiological, neurological findings and laboratory results of 194 patients were analyzed together. Patients were divided into two groups regarding the occurrence of neurological complications and were compared in terms of gender, age, laboratory findings, treatment, survival and relapse.

Results: Neurological complications were observed in 28 of 194 patients throughout the treatment process who did not have a central nervous system involvement at the time of diagnosis. The most common neurological complication was convulsion (7.7%). Although the majority of patients with neurological complications were male, no statistically significant correlation was found between gender, age and the complication occurrence. It was detected that the leukocyte levels at the time of diagnosis were high in patients with neurological complications. These high levels were found to be related with the increased the risk of complication occurrence during chemotherapy. Although the survival rate of patients with neurological complications were lower, no statistically significant difference was found in terms of survival rate between these two groups.

Conclusion: It should be kept in mind that high leukocyte level at the time of diagnosis, which is known to be a poor prognostic factor in pediatric patients with acute lymphoblastic leukemia, might also be a precursor of neurological complications those occur during the treatment.

Anahtar Kelimeler

Acute, childhood, convulsions, grand mal, lymphoblastic leukemia, neurological manifestation, pediatrics, survival

Akut lenfoblastik lösemili çocuklarda nörolojik komplikasyonların ve prognozun değerlendirilmesi

Öz

Amaç: Bu çalışmada, akut lenfoblastik lösemi (ALL) tanısıyla tedavi edilmiş çocuk hastaların tedavi esnasında görülen nörolojik komplikasyonların değerlendirilmesi, tanıda ve tedavide nörolojik komplikasyon görülme risk faktörlerinin saptanması ve nörolojik komplikasyonların prognoza etkisinin değerlendirilmesi amaçlanmıştır.

Yöntemler: Çalışmamızda kliniğimizce Ocak 2006 ile Aralık 2011 tarihleri arasında 18 yaş altı ALL tanısı almış ve Berlin Frankfurt Münster (BFM) TR ALL-2000 kemoterapi protokolü uygulanmış olan hastalar, hastane dosya ve kayıt sisteminden geriye dönük incelenmiştir. Çalışmaya dâhil edilen 200 hastanın 6’sı ilk tanıda merkezi sinir sistemi tutulumu olması nedeniyle çalışma dışı bırakıldı. Yüz doksan dört hastanın demografik, klinik, laboratuvar, radyolojik ve nörolojik bulguları değerlendirmeye alındı. Nörolojik komplikasyon görülen olgularla görülmeyen olgular iki gruba ayrılıp cinsiyet, yaş, laboratuvar, tedavi, sağ kalım ve relaps açısından kıyaslandı.

Bulgular: İlk tanıda merkezi sinir sistemi tutulumu olmayan 194 hastanın 28’inde tedavi esnasında nörolojik komplikasyon görüldü. En sık saptanan nörolojik komplikasyon konvülzyondu (%7,7). Nörolojik komplikasyon gelişen hastalarda erkeklerin çoğunlukta olduğu görülmekle birlikte, cinsiyet ve yaş ile nörolojik komplikasyon gelişimi açısından istatistiksel anlamlı ilişki saptanmadı. (p<0,05) Nörolojik komplikasyon görülen hastalarda ilk tanıda lökosit değerlerinin yüksek olduğu ve lökosit yüksekliğinin nörolojik komplikasyon riskini arttırdığı görüldü. Nörolojik komplikasyon görülen hastaların sağ kalım yüzdesinin daha düşük olduğu görülmesine rağmen bu iki grup arasında sağ kalım oranları karşılaştırıldığında istatiksel anlamlı farklılık bulunmadı. (p>0,05)

Sonuç: Çocukluk çağı ALL’sinde kötü bir prognostik faktör olduğu bilinen tanıdaki lökosit sayısının yüksekliğinin, tedavi esnasında görülebilecek nörolojik komplikasyonların habercisi olabileceği akılda tutulmalıdır.

Anahtar Kelimeler

Akut, çocukluk çağı, grand mal, konvülzyon, lenfoblastik lösemi, nörolojik belirtiler, pediatri, sağkalım

Kaynakça

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