MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN
Main Article Content
Keywords
Mature B cell non Hodgkin Lymphoma, Acute Mortality, Sepsis, Malnutrition, Tumor Lysis Syndrome
Abstract
Background:
Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL.
Methods:
A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection
Results:
Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile. Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality. Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome.
Conclusion:
Rate of acute mortality in B cell NHL is high in our set up and significant risk
factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.
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References
2. Faizan M, Anwar S, Khan S. Demographics and Outcome in Paediatric Non-Hodgkin Lymphoma: Single Centre Experience at the Children Hospital Lahore, Pakistan. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2018 Jan; 28(1):48-51.
3. Minard-Colin V, Brugières L, Reiter A, Cairo MS, Gross TG, Woessmann W, Burkhardt B, Sandlund JT, Williams D, Pillon M, Horibe K. Non-Hodgkin lymphoma in children and adolescents: progress through effective collaboration, current knowledge, and challenges ahead. Journal of Clinical Oncology. 2015 Sep 20; 33(27):2963.Patte C, Auperin A, Gerrard M, et al. Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell nonHodgkin lymphoma in children and adolescents: It is possible to reduce treatment for the early responding patients. Blood 2007; 109:2773–2780.
4. Patte C, Auperin A, Gerrard M, et al. Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell nonHodgkin lymphoma in children and adolescents: It is possible to reduce treatment for the early responding patients. Blood 2007; 109:2773–2780.
5. Patel A, Sharma MC, Mallick S, Patel M, Bakhshi S. Poor performance status, urban residence and female sex predict inferior survival in pediatric advanced stage mature B-NHL in an Indian tertiary care center. Pediatric hematology and oncology. 2018 Jan 2; 35(1):23-32.
6. Cunha KC, Oliveira MC, Gomes AC, Castro LP, Viana MB. Clinical course and prognostic factors of children with Burkitt's lymphoma in a developing country: the experience of a single centre in Brazil. Revista brasileira de hematologia e hemoterapia. 2012; 34(5):361-6.
7. Mobark NA, Tashkandi SA, Al Shakweer W, Al Saidi K, Fataftah SA, Al Nemer MM, Alanazi A, Rayis M, Ballourah W, Mosleh O, Ullah Z. Pediatric non-Hodgkin lymphoma: a retrospective 7-year experience in children & adolescents with non-Hodgkin lymphoma treated in King Fahad Medical City (KFMC). Journal of Cancer Therapy. 2015 Apr 2; 6(04):299.
8. Hirsh MP, Cohen IT. Non-Hodgkin's lymphomas of childhood: An analysis of the history, staging and response to treatment of 338 cases at a single institution: SB Murphy, DL Fairclough, RE Hutchison, et al. J Clin Oncol 7: 186–193, (February), 1989. Journal of Pediatric Surgery. 1989 Nov 1; 24(11):1211.
9. Onis MD, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World health Organization. 2007; 85:660-7.
10. Karadeniz C, Oguz A, Citak EC, Uluoglu O, Okur V, Demirci S, Okur A, Aksakal N. Clinical characteristics and treatment results of pediatric B-cell non-Hodgkin lymphoma patients in a single center. Pediatric hematology and oncology. 2007 Jan 1; 24(6):417-30.
11. Moleti ML, Al?Hadad SA, Al?Jadiry MF, Al?Darraji AF, Al?Saeed RM, De Vellis A, Piciocchi A, Uccini S, Foà R, Testi AM. Treatment of children with B?cell non?Hodgkin lymphoma in a low?income country. Pediatric blood & cancer. 2011 Apr; 56(4):560-7.
12. Pourtsidis A, Servitzoglou M, Baka M, Bouhoutsou D, Varvoutsi M. Pediatric B-cell Non-Hodgkin Lymphoma: 21-year Experience with FAB-LMB Protocols in a Single Institute in Greece. Int J Blood Res Disord. 2015; 2(2):1-4.
13. Radhakrishnan V, Shoufeej P M, Totadri S, Ganesan P, Ganesan T, Sagar T. Pediatric nonblastic non-hodgkin's lymphoma: A perspective from India. Indian J Med Paediatr Oncol 2018;39:13-7
14. Sherief LM, Elsafy UR, Abdelkhalek ER, Kamal NM, Youssef DM, Elbehedy R. Disease patterns of pediatric non Hodgkin lymphoma: A study from a developing area in Egypt. Molecular and clinical oncology. 2015 Jan 1; 3(1):139-44.
15. Kim JS, Kong SG, Oh CE, Yoo HY, Park JS. Treatment Outcomes and Prognostic Factors in Children with Non-Hodgkin Lymphoma at a Single Institution. Clinical Pediatric Hematology-Oncology. 2014 Oct 30; 21(2):86-94.
16. Galardy PJ, Hochberg J, Perkins SL, Harrison L, Goldman S, Cairo MS. Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B?NHL: a Children’s Oncology Group Report. British journal of haematology. 2013 Nov; 163(3):365-72.
17. Co?Reyes E, Li R, Huh W, Chandra J. Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatric blood & cancer. 2012 Dec 15; 59(7):1160-7.
18. Thapa N, Hamal BK, Yadav NP, Thapa G. Bacterial Translocation as a Cause of Postoperative Sepsis in Surgical Patients Undergoing Laparotomy. Journal of Lumbini Medical College. 2014 Dec 30; 2 (2):28-30.