Ye.B. KURAKBAYEV ^1,2, B.S. TURDALIYEVA ¹, L.N. MANZHUOVA ², V.V. SCHUKIN ³

1. «Kazakhstan Medical University «Kazakhstan School of Public Health»» LLP, Almaty, the Republic of Kazakhstan;
2. «Scientific Center of Pediatrics and Pediatric Surgery» JSC, Almaty, the Republic of Kazakhstan;
3. «Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology» FSBI, Moscow, Russian Federation

DOI: https://www.doi.org/10.52532/2663-4864-2023-3-69-38-46

UDC: 616-006.446.2:053.2

Year: 2023 выпуск: 69 number: 3 pages: 38-46

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ABSTRACT

Relevance: Acute lymphoblastic leukemia (ALL) is the most common cancer among children, accounting for nearly a quarter of all childhood cancers.
The study aimed to determine the risk factors and signs of critical conditions in children with acute lymphoblastic leukemia admitted to an intensive care unit (ICU).
Methods: The approach used was a systematic review. Data was collected from sources published in 2019-2023. Four cohort studies, four retrospective analyses, two literature reviews, one case-control study, and one case study were included in this systematic review.
Results: The prognosis in pediatric ALL depends on the initial number of blast cells in the peripheral blood. Patients with B-cell precursor acute lymphoblastic leukemia (BCP ALL) and low blast cell numbers survived better than patients with T-cell acute lymphoblastic leukemia (T-ALL) and low cell count. IL1B and NLRP1 genetic polymorphisms enhanced ALL risk and reduced infectious comorbidity. However, these gene polymorphisms must be confirmed in juvenile leukemia. KRAS, FLT3, NRAS, PTPN11, KMT2D, PTEN, and NOTCH1 gene mutations affected pediatric ALL patient features and treatment results. These mutations demonstrate the relevance of genetic profiling in risk classification and tailored management. Gene variations and availability of effective medication contributed. Pediatric BCP-ALL patients with the PAX5P80R mutation had worse 5-year overall survival, higher white blood cell counts, male preponderance, and more genetic abnormalities. Pediatric BCP-ALL focused on genetic analysis and risk stratification. Children of African American and European American ancestry showed varied incidence, recurrence, and outcome rates for ALL. African American children exhibited lower incidence but greater recurrence rates and poorer prognosis than European American children.
Conclusion: Risk factors for these patients’ admission to ICU include comorbidities, infectious diseases, hypoxia, and hemodynamic instability, as well as age and baseline white blood cell count at diagnosis.
Keywords: Clinical deterioration, signs of critical conditions, intensive care unit (ICU), acute lymphoblastic leukemia
(ALL), children.

List of sources used:

1. Children’s Hospital of Philadelphia. Acute lymphoblastic leukemia (ALL) . 01.07.2023
2. Ahmad I., Ghafoor T., Ullah A., Naz S., Tahir M., Ahmed S., Arshad A., Ali A., Khattack T.A., Batool F. Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years Experience From a Low- and Middle-Income Country // JCO Glob Oncol. – 2023. – Vol. 9. – Art. no. 2200288. https://doi.org/10.1200/GO.22.00288
3. Vijenthira A., Chiu N., Jacobson D., Freedman Z., Cheung M.C., Goddard S., Fowler R., Buckstein R. Predictors of intensive care unit admission in patients with hematologic malignancy // Sci. Rep. – 2020. – Vol. 10, № 1 Art. No. 21145. https://doi.org/10.1038/s41598-020-78114-7
4. Dai Q., Zhang G., Yang H., Wang Y., Ye L., Peng L., Shi R., Guo S., He J., Jiang Y. Clinical features and outcome of pediatric acute lymphoblastic leukemia with low peripheral blood blast cell count at diagnosis // Medicine (Baltimore). – 2021. – Vol.100(4). – Art. no. 24518. https://doi.org/10.1097/MD.0000000000024518
5. Alves F.S., Xabregas L.A., Kerr M.W.A., Souza G.L., Pereira D.S., Magalhães-Gama F., Santiago M.R.R., Garcia N.P., Tarragô A.M., Ogusku M.M., Sadahiro A., Malheiro A., Costa A.G. Genetic polymorphisms of inflammasome genes associated with pediatric acute lymphoblastic leukemia and clinical prognosis in the Brazilian Amazon // Sci. Rep. – 2021. – Vol. 11(1). – Art. no. 9869. https://doi.org/10.1038/s41598-021-89310-4
6. Shen D., Liu L., Xu X., Song H., Zhang J., Xu W., Zhao F., Liang J., Liao C., Wang Y., Xia T., Wang C., Lou F., Cao S., Qin J., Tang Y. Spectrum and clinical features of gene mutations in Chinese pediatric acute lymphoblastic leukemia // BMC Pediatr. – 2023. – Vol. 23(1). – Art. no. 62. https://doi.org/10.1186/s12887-023-03856-y
7. Burke W., Thummel K. Precision medicine and health disparities: The case of pediatric acute lymphoblastic leukemia // Nurs. Outlook. – 2019. – Vol. 67(4). – Р. 331-336. https://doi.org/10.1016/j.outlook.2019.05.003
8. Jung M., Schieck M., Hofmann W., Tauscher M., Lentes J., Bergmann A., Stelter M., Möricke A., Alten J., Schlegelberger B., Schrappe M., Zimmermann M., Stanulla M., Cario G., Steinemann D. Frequency and prognostic impact of PAX5 p.P80R in pediatric acute lymphoblastic leukemia patients treated on an AIEOP-BFM ALL protocol // Genes Chromosomes Cancer. – 2020. – Vol. 59(11). – Р. 667-671. https://doi.org/10.1002/gcc.22882
9. Chu J., Cai H., Cai J., Bian X., Cheng Y., Guan X., Chen X., Jiang H., Zhai X., Fang Y., Zhang L., Tian X., Zhou F., Wang Y., Wang L., Li H., Kwan Alex L.W., Yang M., Yang H., Zhan A., Wang N., Hu S. Prognostic significance of steroid response in pediatric acute lymphoblastic leukemia: The CCCG-ALL-2015 study // Front. Oncol. – 2022. – Vol.12. – Art. no. 1062065. https://doi.org/10.3389/fonc.2022.1062065
10. Brown A.L., Raghubar K.P., Taylor O.A., Bernhardt M.B., Kahalley L.S., Pan W., Lupo P.J., Hockenberry M.J., Scheurer M.E. Prospective patient-reported symptom profiles associated with pediatric acute lymphoblastic leukemia relapse // Support Care Cancer. – 2021. – Vol. 29(5) – Р. 2455-2464. https://doi.org/10.1007/s00520-020-05773-7
11. Liu F., Chen X.J., Guo Y., Yang W.Y., Chen X., Zhang X.Y., Zhang R.R., Ren Y.Y., Zhu X.F. [Efficacy and prognostic factors of the chemotherapy regimen of CCLG-ALL-2008 on pediatric acute lymphoblastic leukemia with ETV6-RUNX1 rearrangement] // Zhonghua Xue Ye Xue Za Zhi. – 2020. – Vol. 41(11). – Р. 896-902 [in Chinese]. https://doi.org/10.3760/cma.j.issn.0253-2727.2020.11.003
12. Küpfer L., Meng B., Laurent D., Zimmermann M., Niggli F., Bourquin J.P., Malene I. Treatment of children with acute lymphoblastic leukemia in Cambodia // Pediatr. Blood Cancer. – 2021. – Vol. 68(10). – Art. no. 29184. https://doi.org/10.1002/pbc.29184
13. Nearing J.T., Connors J., Whitehouse S., Van Limbergen J., Macdonald T., Kulkarni K., Langille M.G.I. Infectious Complications Are Associated With Alterations in the Gut Microbiome in Pediatric Patients With Acute Lymphoblastic Leukemia // Front. Cell. Infect. Microbiol. – 2019. – Vol. 9. – Art. no. 28. https://doi.org/10.3389/fcimb.2019.00028
14. Kashef A., Khatibi T., Mehrvar A. Prediction of Cranial Radiotherapy Treatment in Pediatric Acute Lymphoblastic Leukemia Patients Using Machine Learning: A Case Study at MAHAK Hospital // Asian Pac. J. Cancer Prev. – 2020. – Vol. 21(11). – P. 3211–3219. https://doi.org/10.31557/APJCP.2020.21.11.3211
15. Zou Q., Ma S., Tian X., Cai Q. Comprehensive view on genetic features, therapeutic modalities and prognostic models in adult T-cell lymphoblastic lymphoma // Blood Sci. – 2022. – Vol. 4(3). – Р. 155-160. https://doi.org/10.1097/BS9.0000000000000114
16. Rheingold S.R., Lingyun Ji., Xinxin Xu., Devidas M., Brown P.A., Gore L., Winick N.J., Carroll W.L., Hunger S., Raetz E.A., Loh M.L., Bhojwani D. Prognostic factors for survival after relapsed acute lymphoblastic leukemia (ALL): A Children’s Oncology Group (COG) study // JCO. – 2019. – Vol. 37(15). – Art. no. 10008. https://doi.org/10.1200/JCO.2019.37.15_suppl.10008
17. Roberts K.G. Genetics and prognosis of acute lymphoblastic leukemia in children vs adults // Hematology Am. Soc. Hematol. Educ. Program. – 2018. – Vol. 2018(1). – P. 137-145. https://doi.org/10.1182/asheducation-2018.1.137
18. Kanwar V.S. Pediatric Acute Lymphoblastic Leukemia // Pediatrics: Gen. Med. – Upd. 22.07.2022. https://emedicine.medscape.com/article/990113-overview. 24.09.2023
19. Lee S.H.R., Yang W., Gocho Y., John A., Rowland L., Smart B., Williams H., Maxwell D., Hunt J., Yang W., Crews K.R., Roberts K.G., Jeha S., Cheng C., Karol S.E., Relling M.V., Rosner G.L., Inaba H., Mullighan C.G., Pui C.H., Evans W.E., Yang J.J. Pharmacotypes across the genomic landscape of pediatric acute lymphoblastic leukemia and impact on treatment response // Nat. Med. – 2023. – Vol. 29(1). – P. 170-179. https://doi.org/10.1038/s41591-022-02112-7
20. Dendir G., Awoke N., Alemu A., Sintayhu A., Eanga S., Teshome M., Zerfu M., Tila M., Dessu B.K., Efa A.G., Gashaw A. Factors Associated with the Outcome of a Pediatric Patients Admitted to Intensive Care Unit in Resource-Limited Setup: Cross-Sectional Study // Pediatric Health Med. Ther. – 2023. – Vol. 14. – P. 71-79. https://doi.org/10.2147/PHMT.S389404
21. Ungar S.P., Solomon S., Stachel A., Shust G.F., Clouser K.N., Bhavsar S.M., Lighter J. Hospital and ICU Admission Risk Associated With Comorbidities Among Children With COVID-19 Ancestral Strains // Clin. Pediatr. (Phila) – 2023. – Vol. 20. – Art. no. 99228221150605. https://doi.10.1177/00099228221150605
22. Caballero M., Faura A., Margarit A., Bobillo-Perez S., Català A., Alonso-Saladrigues A., Conde N., Balaguer M., Rives S., Jordan I. Outcomes for paediatric acute leukaemia patients admitted to the paediatric intensive care unit // Eur J Pediatr. – 2022. – Vol.181(3). – P.1037-1045. https://doi.org/10.1007/s00431-021-04292-9
23. Esposito S., Caramelli F., Principi N. What are the risk factors for admission to the pediatric intensive unit among pediatric patients with COVID-19? // Ital J. Pediatr. – 2021. – Vol. 47, № 1. – P. 1-4. https://doi.org/10.1186/s13052-021-01057-w
24. Prévost B., Retbi A., Binder-Foucard F., Borde A., Bruandet A., Corvol H., Gilleron V., Le Bourhis-Zaimi M., Lenne X., Muller J., Ouattara E., Séguret F., Tran Ba Loc P., Tezenas du Montcel S. Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France // Front. Pediatr. – 2022. – Vol. 10. – Art. no. 975826. https://doi.org/10.3389/fped.2022.975826
25. Allison B.L., Caitlin W.E., Yimei Li., Yuan-Shung V., Huang M.S., Brian T. F., D.O., Dean D., Richard A., Kelly D.G. Evaluation of hospital admission patterns in children receiving treatment for acute lymphoblastic leukemia: What does a typical leukemia experience look like? // Blood. – 2018. – Vol. 132 (Suppl. 1). – Р. 4763. https://doi.org/10.1182/blood-2018-99-119970
26. Kurakbaev E.B., Turdalieva B.S., Manzhuova L.N., Omarova K.O., Abdilova G.K., Kusainov A.Z., Saparbaev S.S., Shhukin V.V. Mezhdunarodnyj opyt primenenija sistemy pediatricheskih priznakov rannego preduprezhdenija kriticheskih sostojanij u onkologicheskih detej: obzor literatury // Onkologija i Radiologija Kazahstana. – 2023. – №2(68). – S. 69-75 (in Russ.). https://www.doi.org/10.52532/2521-6414-2023-2-68-69-75