SERUM FERRITIN CONTENT AND INCIDENCE AND TYPE OF INFECTIOUS AND INFLAMMATORY COMPLICATIONS IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA, RESIDING IN RADIOLOGICALLY CONTAMINATED TERRITORIES OF UKRAINE AFTER THE ChNPP ACCIDENT.

OBJECTIVE

evaluation of the frequency and type of bacterial fungal complications and outcome of acute lymphoblastic leukemia (ALL) taking into account the serum ferritin content in children, residing in radiologically contaminated territories (RCT) of Ukraine after the ChNPP accident.

MATERIALS AND

METHODS

Pediatric ALL patients (n = 146), residing in RCT of Ukraine, were the study subjects within a survey period of 15 years. The ALL diagnosis and distribution of patients by the disease variants were heldaccording to the FAB classification and results of immunophenotyping of the bone marrow blast cells. Chemotherapy(CT) was prescribed according to the BerlinFrankfurtMunster group (BFM) protocols. Patients were examined afterthe remission induction therapy. Incidence and type of the bacterial fungal and toxic complications were assessed.The number of deaths was taken into account depending on the age, ALL variant and serum ferritin (SF) content.Radiation doses to the bone marrow were calculated for the entire period of stay in RCT after the accident.Processing of the obtained materials was carried out using the mathematical statistical methods (Student's andSpearman's correlation coefficients, χ2 Pearson test).

RESULTS

Study subjects were distributed according to the ALL variants, namely proB (n = 21, 14.4 %), «general»type (n = 97, 66.4 %), preB (n = 12, 8.2 %), and TALL (n = 16, 11.0 %). Three groups were formed taking intoaccount the SF levels: Group I (n = 53) - SF up to 200 ng/ml, Group II (n = 49) - SF from 200 ng/ml to 500 ng/ml,Group III (n = 44) - SF above 500 ng/ml. The blood hemoglobin level and RBC count were decreased along theincrease in SF content (p < 0.05). A direct correlation was found between the SF content and RBC average volume(r = 0.45; р < 0.05). Anemia was of a normocytic type. The lowest number of cases with iron overload was among thechildren with preBHLL disease variant (1 out of 12). An inverse correlation was established between the transferrin concentration and average hemoglobin content in RBC (r = 0.6; р < 0.05). Sepsis and infections of the anal areawere more often observed in the patients with SF level above 200 ng/ml. The course of pneumonia was complicated in case of SF level above 500 ng/ml. The oral cavity and intestinal mucositis did not depend on SF level.Incidence of the systemic toxic effects after chemotherapy was increased under SF level above 500 ng/ml. The number of deaths in children with SF levels above 500 ng/ml was almost doubled. Most of the deaths occurred in thepatients with proBALL (15 out of 21) and TALL (8 out of 16) disease variants. Fewer children had died having the«common» ALL type (14 out of 97, 14.4 %). The number of deaths in case of preBALL variant not depended on SF levels. The «common» type and TALL patients having got iron overload died more often. The average radiationdoses to the bone marrow were (4.9 ± 0.4) mSv and did not affect the remaining parameters.

CONCLUSIONS

Iron excess in the body affects the incidence and type of infectious complications both with the outcome of ALL in children, which requires timely diagnosis and preventive measures.