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Indian Journal of Medical and Paediatric Oncology
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Year : 1998  |  Volume : 19  |  Issue : 4  |  Page : 114-120

Morbidity and mortality from infections in Indian Children with acute leukanias


Department of Medical & Peadiatric Oncology, Kidwai Memorial Institute, Banglore

Correspondence Address:
N Lalitha
Department of Medical & Peadiatric Oncology, Kidwai Memorial Institute, Banglore

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Source of Support: None, Conflict of Interest: None


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In this article we describe our experience in treating acute Lymphoblastic leukemia in southern India, paying special attention to the infectious complications encountered. Our of a total of 341 patients less than 25 years of age registered with ALL during the year 1987-92, 206 patients were treated according to a standard treatment protocol (MCP 841 from the National Cancer Institute, USA) Forty percent of the patients were from rural areas and only one third had normal nutritional status (although more than 90 percent had undergone primary Immunization). Forty percent of patients had leukocyte count greater than 50,000 per cumm and 40 percent presented with 'Lymphoma syndrome'. as designated by the CCSG. The documented infections encountered were mainly caused by gram negative bacteria, the most frequent being klebsiella and Psedomonas. Chicken pox and herpes zoster were commonly encountered, and oropharyngeal candiasis frequently complicated chemotherapy. A significant decline in mortality occured over the 4 year period of this protocol based study, due, no doubt, to improved supportive care and routine testing of donated blood for hepatitis B. Deaths prior to therapy, induction deaths and deaths in remission were equally diminished. Induction deaths and deaths in remission were each 4.1 percent in 1990, compared to 9.7 percent and 29 percent respectively in 1987. Familiarization with the infectious complications encountered with intensive treatment protocols, and their management, is vital to the achievement of improved survival results in ALL. inspite of differences in both the patient population and available resources compared to industrialized nations, infectious complications can be kept to an acceptably low level, even with intensive chemotherapy protocols, in the setting of a major cancer institute in a developing country.


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