3 research outputs found
Predictive Factors of Fatal Bleeding in Pediatric Acute Promyelocytic Leukemia (APL)
No full textBackground: Pediatric APL has a higher bleeding risk but better outcomes. This study aimed to identify predictors of fatal bleeding in pediatric APL to optimize early interventions and improve survival in Pakistan.
Methods: A retrospective study was conducted at the Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, from January 2013 to December 2023, using census sampling to analyze data from 51 pediatric APL patients (≤18 years) diagnosed and treated during this period. The severity and type of bleeding were classified using standardized bleeding severity scores. The patients were classified in to standard or high risk categories as per total leucocyte count (TLC). The bleeding events and risk factors to fatal bleeding were noted and compared between the two groups using Independent samplest, Mann Whitney U and Chi square tests. Data analysis was performed using SPSS version 25 and p-value ≤ 0.05 considered statistically significant
Results: Fifty-one pediatric APL patients were included with a median age of 4.75 (4.00) years in high-risk group and 10.0 (6.00) years in low risk group (p<0.001). Mortality and fatal bleeding incidence found to be higher in the high-risk group. Fatal bleeding occurred in 8 (28.57%) high risk patients and 6 (26.08%) low risk group which contributed to mortality. Higher median TLC, Partial Thromboplastin Time (PTT) and activated PTT were noticed in patients who suffered from fatal bleeding. Sixteen (31.37%) patients couldn’t survive with 6 (37.5%) patients suffering a fatal bleeding event which led to death
Conclusion: Higher WBCs, lower platelets and prolonged PT / aPTT are potential risk factors of fatal bleeding and mortality in APL patients
Outcomes Of Infant Acute Lymphoblastic Leukaemia; An Experience From Low Middle Income Country
No full textBackground: Acute Lymphoblastic Leukaemia (ALL) is the most common pediatric malignancy. This study was done to describe the prognostic factors and course of infant ALL in Pakistan.
Methods: This retrospective observational study was performed at the department of Paediatric Oncology/Haematology, CMH Hospital Rawalpindi, Pakistan, from January 2012 to December 2023. Data of infants with confirmed diagnosis of ALL by immunophenotyping and treated as per Interfant 06 protocol were analyzed. Non-probability consecutive sampling technique was adopted. Disease risk stratification was done based on clinical and laboratory markers. Prognostic factors, overall survival (OS), and disease-free survival (DFS) were documented. Statistical analysis was performed using IBM-SPSS Statistics, Version 26.0.
Results: In a total of 47 infants, there were 25 (53.2%) male, and the median age was 9.00 (6.00-10.00) months. Age (p<0.001), and MLL rearrangement (p<0.001) had significant association with disease risk group. During the evaluation period, relapse was noted among 17 (36.2%) cases. Mortality was reported among 33 (70.2%) cases. The median DFS, and OS were 6.90 (1.90-27.3) months, and 9.6 (2.90-29.0) months, respectively. ALL disease risk categorization was found to have significant association with overall survival (p=0.016). Evaluation of laboratory parameters revealed that mortality was significantly associated with higher leukocytes count (p=0.027), and lower platelets count (p=0.010).
Conclusion: The overall mortality in ALL is high. These findings highlight the critical role of risk group stratification, elevated WBC count, and low platelet count in predicting survival outcomes in infant ALL
Frequency and Treatment Outcome of Invasive Fungal Infections in Children with Hematological Malignancies
No full textBackground: Invasive fungal infections are the cause of significant morbidity and mortality among cancer patients of any age group. This research aimed to determine the frequency and treatment outcome of invasive fungal infections in children with hematological malignancies.
Methods: This cohort study was performed at the Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan, from January 2022 to June 2023. Children of either gender aged less than 18 years diagnosed with hematological malignancies were included adopting a non-probability consecutive sampling technique. Treatment followed “Berlin-Frankfurt-Münster (BFM)” based protocols. Outcome in the form of mortality was noted by the end of the study period.
Results: A total of 240 cases of various types of hematological malignancies during the study period and 41 (17.1%) cases were found to have invasive fungal infections. In 41 invasive fungal infections, 28 (68.3%) were male. The mean age was 6.35±3.72 years. Invasive fungal infection was found to be possible, probable, and proven in 34 (82.9%), 6 (14.6%), and 1 (2.4%) cases respectively. Amphotericin B was the most frequent anti-fungal, advised in 23 (56.1%) cases whereas voriconazole was given in 14 (41.5%) patients. The mean duration of treatment was 21±19 days (ranging between 2 to 84 days). Mortality was reported among 10 (24.4%) cases.
Conclusion: The frequency of IFS was 17.1% among children with hematological malignancies. Mortality was relatively high (24.4%) among children with IFIs which warrants early identification and treatment of IFIs among children with hematological malignancies
