Impact of Chemotherapy on Echocardiography, Uric acid and Lactate Dehydrogenase in Children with Acute lymphoblastic leukemia (ALL)

Arash  Alghasi; Roozbeh  Moghaddar; Roya Salehi  Kahyesh; Babak  Najibi; Bijan  Keikhaei; Saeid  Bitaraf

doi:10.18502/ijpho.v15i1.17278

Arash Alghasi Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Roozbeh Moghaddar Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Roya Salehi Kahyesh Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Babak Najibi Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Bijan Keikhaei Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Saeid Bitaraf Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI: https://doi.org/10.18502/ijpho.v15i1.17278

Keywords: Acute lymphoblastic leukemia (ALL), Chemotherapy, Echocardiography, Lactate dehydrogenase

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most prevalent malignancy in pediatrics. ALL blood cancer causes excessive production of immature white blood cells called lymphoblasts or leukemic blasts. Therefore, the present study evaluates the effect of chemotherapy on echocardiography, uric acid (UA) and lactate dehydrogenase (LDH) in ALL children.

Materials and Methods: A quasi-experimental study was designed for 53 ALL patients who referred to Shahid Beqaei 2 in Ahvaz from 2022 to 2023. The inclusion criteria for the studied ALL children aged 2 to 16 years were the maintenance phase of chemotherapy and lack of symptoms of cardiomyopathy. The levels of LDH, UA and echocardiographic parameters were compared before and after chemotherapy through paired sample t-tests. P-values<0.05 were considered significant.

Results: The mean age of the ALL patients was 6.28 ± 4.13 years. Of all the patients, 64% were male. The mean levels of LDH before and after chemotherapy were 1443.36 ± 1373.26 and 534.51 ± 236.61 U/L, and the LDH levels decreased significantly after chemotherapy (P < 0.001). The mean U.A levels before and after chemotherapy were 6.67 ± 6.80 and 5.30 ± 6.15 mg/dl, respectively (P = 0.30). Abnormal echocardiography before and after chemotherapy was observed in 3.76% and 22.64% of the patients, respectively, but the difference was not markedly significant (P = 0.44). The relative risk was estimated to be 0.16, suggesting that the probability of cardiac dysfunction after chemotherapy reduced to approximately 16% of the baseline risk observed before chemotherapy.

Conclusion: The initial evaluation of serum LDH can be beneficial in knowing the response to chemotherapy. So, it is of importance to determine the prognostic value of this biological marker. On the other hand, chemotherapy does not seem to have a significant effect on the mean values of echocardiographic parameters and the level of uric acid.