Contributions
Abstract: PB1636
Type: Publication Only
Background
Iron overload of the body is associated with the risk of development of malignant hematologic pathology and frequency of complications in children with ALL and is one of the causes of patients death .
Aims
The goal is to determine the association of serum ferritin (SF) levels in the debut of ALL in children with the nature of complications, the development of relapses and the prognosis of disease course.
Methods
Serum ferritin (SF) has been determined and anemia has been identified in 146 children with ALL before chemotherapy, as well as in the treatment stages. The analysis of obtained data taking into account the ALL variant , presence of complications (bacterial infections, toxic hepatitis, etc.), number of RBC transfusions during treatment, development of resistance to chemotherapy and the number and nature of ALL relapses. Morphological evaluation of dyserythropoiesis manifestations in bone marrow elements was executed and parametrs of porphyrin metabolism (aminolevulinic acid and porphobilinogen) were studied.
Results
Distribution of 146 patients with ALL was performed by initial SF (before start of treatment) levels: up to 200 ng / mL had 53 patients (36.3%); from 200 to 500 ng / mL, normal - 49 (33.6%); more than 500 ng / mL-44 (30.1%). Anemia was not found in 15.7% of patients. Anemia with normal SF was found in 41.1% of patients, anemia with low SF in 15.9%, and with SF in 27.4%. More patients with iron excess had pro-B-ALL, smaller number of iros excess children suffered from common- ALL variant (rs = 0.48). Bacterial infections were common for patients with SF higher than 200 ng / ml, toxic hepatitis and chemotherapy resistance were found more frequently at SF levels higher than 500 ng / ml (rs = 0.48). The number of erythrocyte transfusions correlated with the development of relapse in children (rs = 0.46). There is direct correlation between SF level and the presence of bone marrow relapse in patients (rs = 0.44). In cases with SF levels above 500 ng / mL, the percentage of sideroblasts and manifestations of dyserythropoiesis were higher in patients with ALL relapses or unfavorable disease course . Excess of iron may be the result of ineffective erythropoiesis, endogenous erythropoietin deficiency, reactive oxygen species levels incrising, and transfusion therapy.The removal of excess iron (reduction of serum ferritin) occurred gradually during the treatment and follow-up of patients, taking into account the established causes. The mean value of SF level before treatment was 784.4 ng / mL, after - 158 ng / mL. Light microscopic examination of the bone marrow revealed increased iron granules in erythroblasts, dyseritropose phenomena.
Conclusion
The results of the studies have shown that iron overload is a severe complication of ALL. Particular attention is paid to the presence of high initial levels of SF in patients before treatment, the development of complications and the substitution of erythrocytic transfusions, which should be considered as a risk factor for development and unfavorable prediction of ALL course in children.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Children, Ferritin, Risk factor
Abstract: PB1636
Type: Publication Only
Background
Iron overload of the body is associated with the risk of development of malignant hematologic pathology and frequency of complications in children with ALL and is one of the causes of patients death .
Aims
The goal is to determine the association of serum ferritin (SF) levels in the debut of ALL in children with the nature of complications, the development of relapses and the prognosis of disease course.
Methods
Serum ferritin (SF) has been determined and anemia has been identified in 146 children with ALL before chemotherapy, as well as in the treatment stages. The analysis of obtained data taking into account the ALL variant , presence of complications (bacterial infections, toxic hepatitis, etc.), number of RBC transfusions during treatment, development of resistance to chemotherapy and the number and nature of ALL relapses. Morphological evaluation of dyserythropoiesis manifestations in bone marrow elements was executed and parametrs of porphyrin metabolism (aminolevulinic acid and porphobilinogen) were studied.
Results
Distribution of 146 patients with ALL was performed by initial SF (before start of treatment) levels: up to 200 ng / mL had 53 patients (36.3%); from 200 to 500 ng / mL, normal - 49 (33.6%); more than 500 ng / mL-44 (30.1%). Anemia was not found in 15.7% of patients. Anemia with normal SF was found in 41.1% of patients, anemia with low SF in 15.9%, and with SF in 27.4%. More patients with iron excess had pro-B-ALL, smaller number of iros excess children suffered from common- ALL variant (rs = 0.48). Bacterial infections were common for patients with SF higher than 200 ng / ml, toxic hepatitis and chemotherapy resistance were found more frequently at SF levels higher than 500 ng / ml (rs = 0.48). The number of erythrocyte transfusions correlated with the development of relapse in children (rs = 0.46). There is direct correlation between SF level and the presence of bone marrow relapse in patients (rs = 0.44). In cases with SF levels above 500 ng / mL, the percentage of sideroblasts and manifestations of dyserythropoiesis were higher in patients with ALL relapses or unfavorable disease course . Excess of iron may be the result of ineffective erythropoiesis, endogenous erythropoietin deficiency, reactive oxygen species levels incrising, and transfusion therapy.The removal of excess iron (reduction of serum ferritin) occurred gradually during the treatment and follow-up of patients, taking into account the established causes. The mean value of SF level before treatment was 784.4 ng / mL, after - 158 ng / mL. Light microscopic examination of the bone marrow revealed increased iron granules in erythroblasts, dyseritropose phenomena.
Conclusion
The results of the studies have shown that iron overload is a severe complication of ALL. Particular attention is paid to the presence of high initial levels of SF in patients before treatment, the development of complications and the substitution of erythrocytic transfusions, which should be considered as a risk factor for development and unfavorable prediction of ALL course in children.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Children, Ferritin, Risk factor