Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Akut Lösemili Çocuklarda Tanıdaki Patolojik Bulgular ve Başvuruda Gecikme Nedenleri: Tek Merkez Deneyimi
Pathological Signs in the Diagnosis and Causes of Delay at Initial Admission in Children with Acute Leukemia: A Single-Center Experience
Serap KİRKİZ KAYALIa , Zühre KAYAa
aGazi Üniversitesi Tıp Fakültesi, Çocuk Hematoloji BD, Ankara, Türkiye
Turkiye Klinikleri J Pediatr. 2024;33(2):35-40
doi: 10.5336/pediatr.2024-101461
Article Language: TR
Full Text
ÖZET
 Amaç: Ülkemizde akut lösemili çocukların başvurudaki patolojik bulgularıyla ilgili araştırmalar olmasına karşın tanıda gecikmeyle ilgili çalışma bulunmamaktadır. Bu nedenle akut lenfoblastik lösemi (ALL) ve akut myeloid lösemi (AML) tanısı alan çocukların başvuru klinik bulgu ve gecikme nedenleri geriye dönük değerlendirildi. Gereç ve Yöntemler: Çocuk Hematoloji bilim dalında 1997-2017 arasında verilerine ulaşılan 165 hastanın ilk tanı başvuru klinik ve laboratuar bulguları kaydedildi. Sadece 62 hastada tanı alana kadar geçen süre ve bu süre içinde yapılan tetkik ve tedaviler ile ilgili tıbbi kayıtlara ulaşıldı. Semptomların başlangıcından tanıya kadar geçen süreye göre hastalar Grup 1 (<15 gün) ve Grup 2 (≥15 gün) olarak ayrıldı. Bulgular: Hastaların %40 kız, %60 erkek, %82 ALL ve yaş ortalaması 67 ay (9- 216), %18 (n=29) AML olup yaş ortalaması 72 ay (8-192) idi. ALL'li çocuklarda boyunda şişlik, AML'li olgularda ise gözde şişlik bulunma oranı anlamlı yüksek saptandı (p<0,05). İlk başvuruda lenfadenopati ve hepatosplenomegali saptanma oranı ALL'li çocuklarda anlamlı yüksekti (p<0,05). Grup 2'de Grup 1'e göre kilo kaybı/terleme yakınması 3,8 kat, lenfadenopati, hepatosplenomegali varlığı 1,8 kat, lösemi tanısı öncesi doktora başvurma oranı 1,7 kat, enfeksiyon nedeniyle antibiyotik kullanma oranı 1,6 kat, nütrisyonel eksiklik nedeniyle Fe+2/B12/folat desteği alma oranı 1,8 kat fazla bulundu. Ortalama lökosit ve trombosit sayıları Grup 1'de sırasıyla 63350,8±20750,3/mm3 ve 44720,7±7050,4/mm3 , Grup 2'de 10900,0±2035,9/mm3 ve 95900,0±13250 idi (p<0,05). Tanıdaki gecikmenin relaps ve ölüm oranında fark oluşturmadığı gözlendi. Sonuç: Çalışmamızda lökositozlu, blast yükü fazla olan hastalar erken tanı alırken sitopenili hastaların geç tanı aldıkları görülmüştür. Gelecekte daha fazla hastada yapılacak çalışmaların erken tanının prognoza etkisini değerlendirmede önemli olacağına işaret etmektedir.

Anahtar Kelimeler: Lösemi; çocuk; gecikmiş tanı
ABSTRACT
 Objective: Although there are researches on the pathologic findings at first presentation in children with acute leukemia in our country, there are no studies on delay in diagnosis. Therefore, clinical findings and reasons for delay in admission of children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were retrospectively evaluated. Material and Methods: Although medical documents of 165 leukemia patients who were admitted in the Department of Pediatric Hematology between 1997 and 2017 were evaluated, the time to diagnosis and the other parameters (laboratory tests and treatment) were available for only 62 patients. According to the period from symptom onset to diagnosis, patients were divided into Group 1 (<15 days) and Group 2 (≥15 days). Results: 40% were female, 60% were male, 82% had ALL with an average age of 67 months (9-216 ), and 18% had AML with an average age of 72 months (8-192). Neck swelling were common in ALL and ocular swelling were common in AML cases (p<0.05). At fisrt presentation, lymphadenopathy and hepatosplenomegaly were frequent in ALL (p<0.05). In Group 2, the rate of weight loss or sweating was 3.8 times higher, the presence of lymphadenopathy and hepatosplenomegaly was 1.8 times higher, the rate of consulting a doctor before the diagnosis was 1.7 times higher, and using antibiotics and Fe+2/B12/folate were 1.6 and 1.8 times higher, respectively. The mean leukocyte and platelet counts were 63350.8±20750.3/mm3 and 44720.7±7050.4/mm3 in Group 1, 10900.0±2035.9/mm3 , and 95900.0±13,250 in Group 2, respectively (p<0.05). The delay in diagnosis did not make a difference in the relapse and death rates. Conclusion: In our study, patients with leukocytosis with blast load were diagnosed early, while patients with cytopenias were diagnosed late. This indicates that future studies on more patients will be important in evaluating the effect of early diagnosis on prognosis.

Keywords: Leukemia; child; delayed diagnosis
REFERENCES:
  1. Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, et al. Clinical presentation of childhood leukaemia: a systematic review and meta-analysis. Arch Dis Child. 2016;101(10):894-901. [Crossref]  [PubMed] 
  2. Clarke RT, Jones CH, Mitchell CD, Thompson MJ. 'Shouting from the roof tops': a qualitative study of how children with leukaemia are diagnosed in primary care. BMJ Open. 2014;4(2):e004640. [Crossref]  [PubMed]  [PMC] 
  3. Carroll WL, Bhatle T. Acute lymphoblastic leukemia. Lanzkowsky P, Lipton JM, Fish JD, eds. Lankowsky's Manual of Pediatric Hematologyand Oncology. 6th ed. USA: Elsevier; 2016. p.367-85. [Crossref] 
  4. Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Pediatr. 2019;19(1):478. [Crossref]  [PubMed]  [PMC] 
  5. Baker JM, To T, Beyene J, Zagorski B, Greenberg ML, Sung L. Influence of length of time to diagnosis and treatment on the survival of children with acute lymphoblastic leukemia: a population-based study. Leuk Res. 2014;38(2):204-9. [Crossref]  [PubMed] 
  6. Llano OG. The complete blood count in the early diagnosis of acute leukemia in children. Medicina Universitaria. 2016;18(73):216-18. [Crossref] 
  7. Murali N, Swamy M, Prasad H, Saha D, Kini J, Kumar N. Significance of serum lactate dehydrogenase in childhood acute lymphoblastic leukaemia. Journal of Clinical and Diagnostic Research. 2017;11(11):1-2. [Crossref] 
  8. Miao P, Sheng S, Sun X, Liu J, Huang G. Lactate dehydrogenase a in cancer: a promising target for diagnosis and therapy. IUBMB Life. 2013;65(11):904-10. [Crossref]  [PubMed] 
  9. Al-Saadoon AE, Al-Naama LM, Hassan JK. Serum lactate dehydrogenase (LDH) activity in children with malignant diseases. Bahrain Medical Bulletin. 2003;25(2):71-3. [Link] 
  10. Dai Q, Liu R, Wang Y, Ye L, Peng L, Shi R, et al. Longer time intervals from symptom onset to diagnosis affect the overall survival in children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2022;44(6):285-92. [Crossref]  [PubMed] 
  11. Biswas S, Chakrabarti S, Chakraborty J, Paul PC, Konar A, Das S. Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features. Asian Pac J Cancer Prev. 2009;10(5):903-6. [PubMed] 
  12. Karimi M, Mehrabani D, Yarmohammadi H, Jahromi FS. The prevalence of signs and symptoms of childhood leukemia and lymphoma in Fars Province, Southern Iran. Cancer Detect Prev. 2008;32(2):178-83. [Crossref]  [PubMed] 
  13. Yasmeen N, Ashraf S. Childhood acute lymphoblastic leukaemia; epidemiology and clinicopathological features. J Pak Med Assoc. 2009;59(3):150-3. [PubMed] 
  14. Safaryan L, Sargsyan L, Hakobyan L, Iskanyan S, Avagyan A, Zohrabyan D, et al. Diagnostic and therapeutic limitations and delayed diagnosis of pediatric hematologic malignancies in armenia: a single-institution report. Clin Lymphoma Myeloma Leuk. 2017;17(1):393-4. [Crossref] 
  15. Mowla MG, Choudhury AM, Khaleque MA, Haque MM, Yasmin T. Physician delay for delayed diagnosis of acute lymphoblastic leukemia among children in a tertiary care hospital. J Pharmacol Pharmaceut Pharmacovig. 2020;4(1):018. [Crossref] 
  16. Lins MM, Amorim M, Vilela P, Viana M, Ribeiro RC, Pedrosa A, et al. Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil. J Pediatr Hematol Oncol. 2012;34(7):e271-6. [Crossref]  [PubMed] 
  17. Haimi M, Peretz Nahum M, Ben Arush MW. Delay in diagnosis of children with cancer: a retrospective study of 315 children. Pediatr Hematol Oncol. 2004;21(1):37-48. [Crossref]  [PubMed] 
  18. Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of childhood cancer in Africa. Pediatr Blood Cancer. 2011;56(1):80-5. [Crossref]  [PubMed] 
  19. Wahl SK, Gildengorin G, Feusner J. Weekend delay in initiation of chemotherapy for acute lymphoblastic leukemia: does it matter? J Pediatr Hematol Oncol. 2012;34(1):e8-e11. [Crossref]  [PubMed] 

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