Modifiye St. Jude Total Xııı Ve Total Xv Protokolü ile Tedavi Edilen Akut Lenfoblastik Lösemili Çocuklarda Tedavi Sonrası Sekonder Kanserler ve İnfertilite Durumunun Değerlendirilmesi

Abstract

Acute lymphoblastic leukemia (ALL) is the most common cancer of childhood period and some complications such as secondary cancers, infertility, and neurocognitive disorders may develop in the long term due to ALL treatment. In this study, it was aimed to analyze secondary cancers, infertility, and some social conditions of ALL patients. Pediatric patients aged 1-18 years who were diagnosed with ALL between January 1, 1997 and January 30, 2016 at Hacettepe University Department of Pediatric Hematology were retrospectively analyzed. During the study period, a questionnaire was applied by calling patients over the age of 18 to inquire about their infertility and social status. In this study, 245 and 183 patients who were treated with Modified St. Jude Total XIII and Total XV protocols respectively, were included and the median follow-up time was 15.5 years. In order to examine the infertile and social situations, a total number of 234 patients (Modified St. Jude Total XIII (n=183), Modified St. Jude Total XV (n=51), respectively) over the age of 18 at the time of the study was included into the study. Among those who received the Modified St. Jude Total XIII protocol, 62 patients were excluded (six patients under the age of 18, one patient who did not consent to participate, and 55 patients who died at the time of the study). Among those who received the Modified St. Jude Total XV protocol, 107 patients under the age of 18 and 25 patients who died were excluded. A total of 10 (4.5%) cases with secondary cancer were observed who were treated with Modified St. Jude Total XIII protocol, compared with no cases who were treated with Modified St. Jude Total XV protocol (p=0.006). Secondary cancers were glial tumors (n=2), meningioma (n=1), thyroid cancer (n=2), acute myeloblastic leukemia (n=2), squamous cell carcinoma of the tongue (n=1), breast cancer (n=1), and T-cell lymphoblastic lymphoma (n=1). The median time to develop secondary central nervous system tumors from the time of the diagnosis was 14 (8.4-23.3) years, while the median time to develop secondary acute myeloid leukemia was 3 (2.2-3.8) years. When compared patients who developed secondary cancers with the patients who did not, there was no statistical difference in terms of gender, age at diagnosis, initial white blood cell count, immune phenotype, risk groups, relapse site, radiation therapy, and radiation therapy site (p>0.05). However, multivariate analysis revealed that traumatic LP increases the risk of developing secondary cancer 4.8 times and relapse 4.5 times. When we looked at the marrital status of some of those ALL patients, we found that the marrital status of the patients who were received Modified St. Jude Total XIII and XV protocols were 25.4% and 7.7% respectively. We observed that the marriage age of our patients was above the marriage age of the general population in Turkey (27 years, and 24 years respectively). There were five patients (four men and one woman) who met the definition of infertility which is interestingly all of these patients were received an intermediate/high-risk protocol during the puberty period. Moreover, four of the five patients had a history of radiotherapy. And we observed a higher education level among our ALL cases which is higher than the general population (68.4%, and 20.8% respectively) The five-year overall survival rate of patients who were treated with Modified St. Jude Total XIII protocol was 85.8± 2.4% and event-free survival was 78.7±2.8%. Five-year overall survival was 89.2±2.3% and event-free survival was 85.6±2.6% in patients who were treated with Modified St. Jude Total XV protocol. When comparing patients with and without secondary cancer, there is no statistically significant difference between the five-year and ten-year overall survival rates. Considering long-term outcomes in a large group of leukemias, we analyzed the many diagnostic and therapeutic features that may affect secondary cancer and infertility, in this study. In conclusion; reducing the problems that ALL patients may encounter in the long term should be one of the goals of ALL treatment and expanding knowledge to be obtained in that will contribute to this.