Early response to treatment and adverse events in pediatric acute
promyelocytic leukemia: a single center observational study in
Bangladesh
Abstract
Abstract: Objective: Pediatric acute promyelocytic leukemia (APL) is one
of the most curable subtypes of acute myeloid leukemia of childhood. But
it may have many early complications, especially in developing
countries. This study aims to describe the early course of disease and
adverse events in the management of pediatric APL cases in Bangladesh.
Method: This prospective observational study was conducted in the
Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh
Mujib Medical University, Dhaka from September 2017 to March 2019. The
study included twenty PML:RAR-α (ProMyelocytic Leukemia-Retinoic Acid
Receptor-α) positive APL cases. After taking informed written consent
from the parents, patients were treated with risk directed ATRA
(All-trans-retinoic acid) based chemotherapy. Results: The mean age was
6.8 years with male-female ratio of 1:1.2. Hemorrhagic manifestations
were observed in 95% of patients, with mucosal bleeding in 55% and CNS
hemorrhage in one patient. Fever was the present in 95% of children.
Most of the children (65%) were in the high risk group. DIC was present
in 90% cases and mean D-Dimer was 4.1 µg /ml. Overall 90% (18/20)
patients achieved clinical and peripheral remission with resolution of
coagulopathy. But only 75% patients (15/20) reached maintenance therapy
in bone marrow remission. Causes of deaths were neutropenic sepsis,
intracranial hemorrhage, complicated differentiation syndrome and
stroke. Neutropenic sepsis was the most common adverse event.
Conclusion: In Bangladeshi pediatric APL patients, neutropenic sepsis is
the most common and also the most severe adverse event. Key words: acute
promyelocytic leukemia, children, response to treatment