[Digestive disease in the immunocompromised patient with acute lymphoblastic leukemia. Experience of the IVth Pediatric Clinic--Oncology Department of the Iaşi Sfânta Maria Children's Hospital].

The goals of this paper were to study the various types of digestive disease in acute lymphoblastic leukemia (ALL), to characterize the children in the study group by age, sex and environment, by presence of liver and spleen enlargement, levels of GOT, GPT, vomiting, to evaluate methotrexate (MTX) serum levels al 24 hours and 48 hours after administration, and to analyze the correlation between MTX levels and MTX liver and blood toxicity.

METHODS

We studied 39 immunocompromised children hospitalized in the IV-th Pediatric Clinic-Oncology Ward, between 1983-2005, with acute lymphoblastic leukemia (ALL); most of them exhibited defects of humoral immunity such as transitory hypogammaglobulinemia, and defects of the cellular immunity that accompanied hepatomegaly, hepatic cytolysis and biliary obstruction.

RESULTS

The diagnostic of ALL was sustained by: medullar biopsy, lumbar punction, cytochemical reactions, blood cell count, flow-cytometry, methotrexate level determination. Hepatic damage was measured by: GOT, GPT, bilirubin, LDH, GGT, FA, HBS antigen, anti HCV antibodies, anti HVA antibodies, anti toxoplasmosis antibodies, anti CMV antibodies, serum protein levels, TQ, inflammation markers. A slight increase in the number of diagnosed ALL cases during the past two decades was noticed and ALL incidence was higher in boys than girls. Hematologic toxicity of MTX is a real problem, causing neutropenia. MTX also caused oral lesions (in 69.36% of children), vomiting (in 69.2% of children) and liver toxicity (in 51.3% of children). MTX serum level 24 hours after administration is significantly different from the serum level at 48 hours after administration. Thus, the use of calcium folinate is proved to be very effective. We have also demonstrated that vomiting had some other causes besides MTX administration.