Chemotherapy-induced Thrombocytopenia in Pediatr ic Acute Lymphoblastic Leukemia: A Single-Institution Report

Background: Thrombocytopenia is one of the most common toxicities of chemotherapy, causing symptoms ranging from mild petechiae to debilitating bleeding. These effects can lead to treatment delay and discontinuation, which subsequently affects outcome. The data on chemotherapy-induced thrombocytopenia is scarce, especially from the developing world, and until now there is no consensus on the appropriate management of this complication.
Aim: The aim of this study was to evaluate chemotherapy-induced thrombocytopenia in pediatric patients with acute lymphoblastic leukemia.
Methods: Medical records of acute lymphoblastic leukemia patients who were diagnosed and treated in 2019 at the only center for pediatric hematologic and oncologic disorders in Armenia – the Pediatric Cancer and Blood Disorders Center of Armenia – were retrospectively reviewed.
Results: A total of 29 patients with acute lymphoblastic leukemia, who were subsequently treated with International BFM (Berlin, Frankfurt, Muenster) Study Group acute lymphoblastic leukemia IC BFM 2009 protocol and achieved remission, were included in the current study. 17 (58%) patients were males. The median age
was 4.5y. and range, 18 months – 17 years. 5 patients had T-acute lymphoblastic leukemia and 24 patients, Bacute lymphoblastic leukemia. During induction therapy, 11 patients (38%) developed critical thrombocytopenia with platelet counts ranging from 21×10 3/L to 46×103/L. During consolidation therapy, 16 patients (55%) developed moderate thrombocytopenia, with platelet counts ranging from 70×103/L to 86×103
/L and 6 (21%) patients had critical thrombocytopenia, with platelet counts ranging from 27×103/L to 36×103/L. During the re-induction phase of therapy, 21 (72%) patients developed critical chemotherapy-induced thrombocytopenia with platelet counts ranging from 13×103/L to 45×103/L. Isolated thrombocytopenia occurred in 3 (10%) of the patients. Thrombocytopenia was managed by platelet transfusion. The median (range) pre-transfusion platelet count was 10×109/L (5×109–13×109
/L) and increased significantly post-transfusion to 22×109/L.
Conclusions: During the course of therapy the vast majority of patients with acute lymphoblastic leukemia developed clinically significant thrombocytopenia. Although our study is small and involves the cases from one year, it includes all the acute lymphoblastic leukemia patients treated in Armenia. The study clearly shows that chemotherapy-induced thrombocytopenia is a very common complication of acute
lymphoblastic leukemia therapy and larger studies needed to explore these findings.