High burden of clinically significant adverse events associated with contemporary therapy for pediatric T‐cell acute lymphoblastic leukemia/lymphoma

Abstract

AbstractBackgroundDespite improvements in survival for children with T‐cell acute lymphoblastic leukemia and lymphoma (T‐ALL/LLy), morbidity remains high. However, data are lacking regarding comprehensive descriptions of clinically relevant adverse events (AEs) experienced during early intensive chemotherapy.ProcedureThis single‐institution retrospective study evaluated children aged 1–21 years with T‐ALL/T‐LLy diagnosed from 2010 to 2020. Physician chart abstraction identified and graded 20 clinically relevant AEs. AE rates were analyzed by T‐ALL or LLy, minimal residual disease status, induction steroid, and use of antimicrobial prophylaxis. Statistical comparisons used the Kruskal–Wallis test (continuous variables) and Chi‐square or Fisher's exact test (categorical variables).ResultsThe cohort included 120 patients (T‐ALL: 88; T‐LLy: 32). Most patients experienced AEs during induction (85 out of 120; 70.8%) and consolidation (89 out of 111; 80.2%). Nonsepsis infection was common in induction (26 out of 120; 21.7%) and consolidation (35 out of 111; 31.5%). Patients treated with dexamethasone during induction had significantly higher rates of nonsepsis infection and/or sepsis during consolidation than those who received prednisone (p < .01).ConclusionsClinically significant AEs are extremely common during induction and consolidation therapy for patients with T‐ALL/LLy. Infectious AEs are particularly prevalent. These results can inform conversations with patients and families and aid in the development of toxicity‐related aims in the next generation of, prospective clinical trials in T‐ALL/LLy.