From the Guidelines
Children undergoing lymphoma treatment are at high risk of developing serious infections, profound neutropenia, and severe mucosal toxicity, which can lead to significant morbidity and mortality if not promptly managed. The signs of toxicity associated with lymphoma treatment in children include bone marrow suppression, gastrointestinal toxicities, neurotoxicity, cardiotoxicity, hepatotoxicity, and nephrotoxicity 1. Specifically, the treatment regimens recommended for pediatric patients with Burkitt lymphoma (BL) or diffuse large B-cell lymphoma (DLBCL) can cause organ dysfunction and tumor mass effects, resulting in spinal cord compression, kidney injury, obstructive uropathy, intussusception, bowel obstruction, and hepatopathy 1.
Some key signs of toxicity to monitor for include:
- Neutropenia and severe mucosal toxicity, which can increase the risk of serious infections 1
- Hepatitis B reactivation in patients receiving rituximab, which requires hepatitis B virus polymerase chain reaction monitoring and antiviral prophylaxis for HBsAg-positive patients 1
- Tumor lysis syndrome, which can present with hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, particularly at treatment initiation
- Cardiotoxicity, hepatotoxicity, and nephrotoxicity, which can lead to arrhythmias, decreased cardiac function, elevated liver enzymes, jaundice, electrolyte imbalances, and decreased kidney function
Regular monitoring through blood tests, physical examinations, and sometimes cardiac or neurological assessments is essential for early detection and management of these side effects 1. It is crucial to note that the management of these toxicities requires a multidisciplinary approach, including supportive care, infection prophylaxis, and treatment of organ dysfunction and tumor mass effects 1.
From the Research
Signs of Toxicity in Lymphoma Treatment
The signs of toxicity associated with lymphoma treatment in children can be identified through various studies. Some of the key findings include:
- Febrile neutropenia, hypertension, and thrombocytopenia are common treatment-related toxicities in children and adolescents with acute lymphoblastic leukemia 2
- Vincristine-induced peripheral neuropathy is a common toxicity in children treated for acute lymphoblastic leukemia, observed in 70 out of 73 patients in one study 3
- Cardiovascular, respiratory, gastrointestinal, renal, and infectious toxicities are associated with worse survival in patients with acute lymphoblastic leukemia 2
- Chemotherapy treatment can cause myelosuppression, including severe leucopenia and anaemia, especially in patients with inflammatory or B symptoms 4
- Long-term toxicity of chemotherapy and radiotherapy in lymphoma survivors can include cardiac dysfunction, second malignancy, and infertility 5
Toxicity Patterns in Children
Toxicity patterns in children treated for lymphoma can follow a typical pattern, with most toxicities occurring in relation to specific treatment phases 3. Some of the factors that can influence the risk of toxicity include:
- Age, with older children being more prone to toxicity 3
- Sex, with female sex being associated with a higher tendency towards toxicity 3
- Presence of inflammatory or B symptoms, which can predict greater toxicity from chemotherapy 4
Monitoring and Management
It is essential to monitor patients for signs of toxicity and manage them promptly to minimize the risk of long-term complications. This can include: