ABSTRACT
BACKGROUND: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a well-known adverse effect of vincristine (VCR). Literature suggests that Asians are predisposed to develop SIADH following VCR administration. However, data regarding the occurrence of SIADH in children with malignancy are limited. This study aims to analyze the incidence, clinical picture, risk factors, management, and outcome of SIADH during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: A prospective study was conducted among the 166 newly diagnosed pediatric ALL patients who were treated at a tertiary cancer center in India between January 2015 and December 2015. Patients who developed hyponatremia during induction chemotherapy were further investigated for SIADH. RESULTS: The incidence of SIADH was 10.8% (n = 18) with a mean sodium level of 125 mEq/L (114–129 mEq/L). In the preceding 2 weeks, 72% of episodes were associated with the administration of two (n = 6) or three (n = 7) doses of VCR. One child presented with seizures. All the patients were managed with fluid restriction and only two patients required sodium correction with 3% saline. Girls older than 10 years of age showed a marginally significant correlation to develop SIADH (P-value = 0.059). CONCLUSION: We report a higher incidence of SIADH (10.8%) in Indian children, compared to that described in the literature, during induction chemotherapy for ALL. Regular monitoring of sodium levels during this period of chemotherapy is hence essential for the timely diagnosis and appropriate management of SIADH, which in turn will avert complications, including neurological symptoms secondary to SIADH.
ABSTRACT
Objective: To find out prevalence of iron overload in children with leukemia at the end oftreatment, and to identify factors affecting iron overload. Methods: Children (age-1-14 y)treated for Leukemia of our center who completed treatment between January and August2016 were included in the study. Serum ferritin and iron were measured at completion oftreatment and total blood transfusion received throughout treatment was quantified. Serumferritin >1000 ng/mL was considered as marker of transfusional iron overload. Results: Outof 66 participants, 55 (83.3%) received red cell transfusions. Average transfused volumewas 48 mL/kg, and patients with high-risk leukemia received more transfusions thanstandard-risk patients. 16 patients (24.2%) demonstrated transfusional iron overload. Totaltransfused volume and treatment intensity were significant factors associated with ironoverload, and total transfused volume of >100 mL/kg (approximately 10 transfusions) wasthe most important determinant of transfusional iron burden. Conclusion: One-fourth ofpediatric leukemia patients demonstrated iron overload at the end of treatment. Thesepatients need to be monitored and followed-up after treatment to assess need for laterchelation therapy.