A complication during chemotherapy of recurrence of acute lymphoblastic leukemia in a child

Acute lymphoblastic leukemia (ALL) is one of the most common malignant diseases of the hematopoiesis system in childhood, characterized by uncontrolled proliferation of a tumor clone from lymphocyte progenitor cells. At the same time, as a result of total immunosuppression, the most common complications are infectious. The purpose of the work: to describe a clinical case of nosocomial pneumonia, formed against the background of chemotherapy relapse of ALL. Materials and methods. A retrospective analysis of the medical records of patient L., 6 years old, who was being treated at the Department of Pediatric Pulmonology of the UKB No. 1 of the Razumovsky SSMU with the main diagnosis: Nosocomial polysegmental pneumonia with obstructive syndrome, acute course. Complications: 1. RF III art., 2. Pulmonary edema, 3. Exudative pleurisy. Background: ALL III phenotype; late bone marrow relapse, isolated (30.12.2022). Results. At the age of 2 (2019) - he made his ALL debut, received induction courses, and achieved remission within the prescribed consolidation period. In 2022, a reinduction course was conducted, and it was removed from the D-register. Relapse of leukemia (28.12.2022) - hospitalized in the V.Ya. Shustov UCB No. 3, 1 block of anti-relapse therapy of ALL in combination with hemotransfusion, massive antibacterial (AB) therapy was performed. On the 23rd day of hospitalization in the hematology clinic, nosocomial 2-sided polysegmental pneumonia was diagnosed, complicated by pulmonary edema, exudative pleurisy, RF III art. On 23.01.2023, the patient was urgently taken to the children’s Intensive care Unit (DORIT) in extremely serious condition UKB No. 1 named after S.R. Peacemakers SSMU, where over the next 15 bed days he received: erythrocyte suspension transfusion, oxygen therapy, combined AB therapy, GCS, bronchodilator and mucolytic therapy, against which the condition improved: symptoms of intoxication, DN were stopped, the inflammatory process in the lungs was resolved. For further treatment of relapse, ALL was transferred to the hematology clinic. Conclusion: The course of chemotherapy for relapse of ALL in the patient provoked a severe infectious complication - nosocomial pneumonia with DN III art., pulmonary edema, pleurisy. Timely diagnosis of pneumonia and intensive therapy in DORIT conditions contributed to a favorable outcome of the infectious process in the lungs. Taking into account the above, the tactics of ALL management were changed - allogeneic transplantation of hematopoietic stem cells from a haploidentical donor (father) was performed, 19.07.2023 - engraftment was achieved.

nosocomial pneumonia, acute lymphoblastic leukemia, relapse, children

1. Karachunsky A.I. Acute lymphoblastic leukemia, children: clinical recommendations. 2020, 78 p. (in Russ.)@@ Карачунский А.И. Острый лимфобластный лейкоз, дети: клинические рекомендации. 2020. 78 с.

2. Bakradze M.D.Community-acquired pneumonia, children: clinical recommendations. 2022. 74 p. (in Russ.)@@ Бакрадзе М.Д. Внебольничная пневмония, дети: клинические рекомендации. - 2022. - 74 с.

3. Henze G. Protocol for the treatment of children with recurrent forms of acute lymphoblastic leukemia. ALL-REC-MB. 2014. 56 p.

4. Bommart S., Bourdin A., Makinson A. et al. Infectious chest complications in haematological malignancies. Diagnostic and Interventional Imaging. 2013;94(2):193-201. doi: 10.1016/j.diii.2012.12.002.

5. Evans S.E., Ost D. Pneumonia in the neutropenic cancer patient. Current Opinion in Pulmonary Medicine. 2015;21(3):260-271. doi: 10.1097/mcp.0000000000000156.

6. Chesnokova N.P., Nevvazhai T.A., Zhevak T.N. et al. Acute myeloid and lymphocytic leukemia: principles of classification, stages of development. General patterns of clinical manifestations (Lecture 2).International Journal of Applied and Fundamental Research. 2015;7(1):163-166. (in Russ.)@@ Чеснокова Н.П., Невважай Т.А., Жевак Т.Н. и соавт. Острые миело- и лимфолейкозы: принципы классификации, стадии развития. Общие закономерности клинических проявлений (лекция 2). Международный журнал прикладных и фундаментальных исследований. 2015;7(1):163-166.

7. Abdusalamov S.N., Melkova K.N., Gorbunova N.V., Chernyavskaya T.Z. Preventive regimes of patient management and approaches to optimization of accompanying therapy in bone marrow transplantation. Clinical oncohematology. Basic research and clinical practice. 2010;3(1):21-29. (in Russ.)@@ Абдусаламов С.Н., Мелкова К.Н., Горбунова Н.В., Чернявская Т.З. Профилактические режимы ведения больных и подходы к оптимизации сопроводительной терапии при трансплантации костного мозга. Клиническая онкогематология. Фундаментальные исследования и клиническая практика. 2010;3(1):21-29.

8. Harris B., Geyer A.I. Diagnostic Evaluation of Pulmonary Abnormalities in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation. Clinics in Chest Medicine. 2017;38(2):317-331. doi: 10.1016/j.ccm.2016.12.008.

9. Alexandrova T.N., Mulina I.I., Yadrikhinskaya V.N. et al. Clinical and diagnostic features of pneumonia in hematological patients. Crimean Therapeutic Journal. 2019;(3):24-35. (in Russ.)@@ Александрова Т.Н., Мулина И.И., Ядрихинская В.Н. и соавт. Клинико-диагностические особенности пневмонии у гематологических больных. Крымский терапевтический журнал. - 2019. -№3. - С. 24-35.

10. Shamitova E.N., Kuceva A.D., Salakhova Z.I. Acute lymphoblastic leukemia in preschool children. Scientific review. Medical sciences. 2022;(3):81-85. (in Russ.)@@ Шамитова Е.Н., Кучева А.Д., Саляхова З.И. Острый лимфобластный лейкоз у детей дошкольного возраста. Научное обозрение. Медицинские науки. 2022;(3):81-85.

11. Sakaeva D.D., Borisov K.E., Bulavina I.S. et all. Practical recommendations for the diagnosis and treatment of febrile neutropenia. Malignant Tumors: Practical Recommendations. 2022;(12):55-63. (in Russ.)@@ Сакаева Д.Д., Борисов К.Е., Булавина И.С. и соавт. Практические рекомендации по диагностике и лечению фебрильной нейтропении. Злокачественные опухоли: Практические рекомендации. 2022;(12):55-63.

12. Shamanskaya T.V., Kachanov D.Yu., Varfolomeeva S.R., Prevention and treatment of infectious complications in children with malignant tumors. The role of the pediatrician. Journal of Pediatrician Practice. 2009:38-44. (in Russ.)@@ Шаманская Т.В., Качанов Д.Ю, Варфоломеева С.Р. Профилактика и лечение инфекционных осложнений у детей со злокачественными опухолями. Роль педиатра. Журнал Практика педиатра. 2009:38-44.

13. Davydov M.I. Infections in oncology. Practical medicine. 2009:386-388. (in Russ.)@@ Давыдов М.И. Инфекции в онкологии. Практическая медицина. 2009:386-388.

14. Inaba H., Pei D., Wolf J. et al. Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Annals of Oncology. 2016:557. doi: 10.1093/annonc/mdw557.

15. Vento S., Cainelli F., Temesgen Z. et al. Lung infections after cancer chemotherapy. The Lancet Oncology. 2008;9(10):982-992. doi: 10.1016/s1470-2045(08)70255-9.

16. O’Connor D., Bate J., Wade R. et al. Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003. Blood. 2014;124(7):1056-1061. doi: 10.1182/blood-2014-03-560847.

17. Mairuhu A. M., Andarsini M. R., Setyoningrum R. A. et al. Hospital acquired pneumonia risk factors in children with Acute Lymphoblastic Leukemia on chemotherapy. Heliyon. 2021;7(6): e07209. doi: 10.1016/j.heliyon.2021.e07209.

18. Yarets Yu.I., Pugacheva Zh.N., Sochilovich D.S. et al. Immunophenotypic characteristics of acute leukemia in children of the Gomel region. Hematology. Transfusiology. Eastern Europe. 2022;8(4):411-417. (in Russ.) doi: 10.34883/PI.2022.8.4.010.@@ Ярец Ю.И., Пугачева Ж.Н., Сачилович Д.С. и соавт. Иммунофенотипическая характеристика острого лейкоза у детей Гомельской области. Гематология. Трансфузиология. Восточная Европа. 2022;8(4):411-417. doi: 10.34883/PI.2022.8.4.010.

19. Galeeva A.V., Gainullina E.A. Antibacterial therapy in the treatment of febrile neutropenia in children. Practical medicine. 2010;1(40):53-57. (in Russ.)@@ Галеева А.В., Гайнуллина Э.А. Антибактериальная терапия в лечении фебрильной нейтропении у детей. Практическая медицина. 2010;1(40):53-57.