Prevalence of 21 Physician-Defined Severe Toxicities Following Childhood Acute Lymphoblastic Leukemia Treatment: Australian Retrospective Cohort Study.

BACKGROUND

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with an overall survival now surpassing 90% in developed countries. However, treatments are not without adverse effects. In this study, we apply the severe toxicity-free survival (STFS) framework to determine the prevalence of 21 physician-defined severe toxicities following ALL treatment.

METHODS

Retrospective cohort study.

INCLUSION: (i) pediatric patients (0-18 years), (ii) treated for ALL at the Royal Children's Hospital, Melbourne, Australia, (iii) treated prior to December 2019, and (iv) >5 years since diagnosis (Dx).

EXCLUSION CRITERIA: (i) pediatric patients with ALL but did not receive treatment, (ii) <5 years since ALL Dx. Toxicity data were captured following review of the patients electronic medical record (EMR) using a list of 21 defined unacceptable toxicities.

RESULTS

We identified 345 patients who received primary ALL treatment at the Royal Children's Hospital, meeting the inclusion criteria of this study. The median age at Dx was 4 years (QR 3-9), and 161 patients (46.7%) were female. A total of 78 patients (22.6%) were identified as having a severe toxicity associated with their ALL treatment. The most common toxicities observed are mental health concerns (9.6%), osteonecrosis (6.7%), and paralytic, neuropathic, myopathic, and movement disorders (4.1%).

CONCLUSION

Our study reveals that 22.6% of patients with ALL experienced severe toxicities according to the STFS endpoint. The prominence of mental health concerns, osteonecrosis, and various movement disorders highlights the diverse nature of these toxicities. Given their severity and breadth, ongoing surveillance and intervention should be incorporated into standard care.