Compromiso hepático durante la fase de mantenimiento de la leucemia linfoblástica aguda pediátrica en una IPS de Barranquilla (2020-2024)
Fecha
2025
Autores
Bastos Mendoza, Jhan José
Molina Pacheco, Katiuska Rosa
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
La leucemia linfoblástica aguda (LLA) es el resultado del compromiso en la diferenciación celular como proliferación aumentada, apoptosis disminuida e incremento de la auto renovación manteniendo la presencia de clonas leucémicas. En general, los protocolos BFM (Berlín Frankfurr Munster) se usan para tratar la leucemia en América Latina, este protocolo consta de 3 fases: inducción, consolidación y mantenimiento; durante estas fases el paciente puede presentar efectos adversos como la hiperbilirrubinemia y los niveles elevados de transaminasas debido a los efectos hepatotóxicos de los fármacos utilizados durante el tratamiento. Objetivo: Identificar el compromiso hepático en la fase de mantenimiento de la LLA en niños en un servicio de consulta externa de Barranquilla (Atl, CO). Metodología: Se trata de un estudio con una profundidad explicativa de tipo inferencial, con una finalidad aplicada con un alcance temporal longitudinal con una revisión de datos retrospectiva. Con un carácter de medida cualitativa ordinal. Se realizó en el servicio de consulta externa de una IPS (Institución Prestadora de Salud) en la ciudad de Barranquilla - Atlántico en el periodo de enero 2020 - noviembre 2024. La población de estudio fueron los pacientes < 18 años con diagnóstico de leucemia linfoblástica aguda quienes presentaron alteración en las enzimas hepáticas en fase de mantenimiento, a los que se les realizó análisis descriptivo e inferencial. Resultados: Se incluyeron 12 pacientes, la edad promedio fue de 10.25 ± 3.62 años, siendo significativamente mayor en hombres que en mujeres (p = 0.034). El 67% pertenecía a estratos socioeconómicos 1 y 2, y la mayoría (90%) no presentó hallazgos clínicos significativos al inicio. Durante la fase de mantenimiento, se observó una disminución progresiva en los niveles normales de GOT (Glutámico Oxalacético Transaminasa) y GPT (Glutamato Piruvato Transaminasa) con un aumento en los niveles elevados (>1x límite superior de normalidad (LSN), >3xLSN, >5xLSN), aunque sin diferencias estadísticamente significativas (GOT: p = 0.6; GPT: p = 0.09). Asimismo, los recuentos de leucocitos disminuyeron significativamente entre el inicio y el final del mantenimiento (p = 0.014). En cuanto al tratamiento, más del 50% de los pacientes recibieron dosis por debajo de la plena tanto para 6-mercaptopurina como para metotrexato. Aunque de transaminasas > 5xLSN fueron más frecuentes en pacientes con dosis por encima de la plena, no se encontraron diferencias estadísticamente significativas (6-mercaptopurina: GOT p = 0.370, GPT p = 0.325; metotrexato: GOT p = 0.634, GPT p = 0.753). Conclusión: Con los resultados se puede concluir que predominan en sexo femenino en LLA en mantenimiento, que las mujeres presentan una edad de debut más temprana que los hombres, se relacionó la elevación de las enzimas hepáticas con el aumento de las dosis de los medicamentos quimioterapéuticos durante la fase de mantenimiento sin embargo no es estadísticamente significativo. A pesar de eso, se destaca que el 30% de los pacientes inician fase de mantenimiento con elevación de las transaminasas por lo que se plantea realizar nuevos estudios orientados en esta área
Acute Lymphoblastic Leukemia (ALL) results from impaired cellular differentiation, increased proliferation, decreased apoptosis, and enhanced self-renewal, maintaining the presence of leukemic clones. In general, the BFM (Berlin-Frankfurt-Münster) protocols are used to treat leukemia in Latin America. This protocol consists of three phases: induction, consolidation, and maintenance. During these phases, patients may experience adverse effects such as hyperbilirubinemia and elevated transaminase levels due to the hepatotoxic effects of the drugs used in the treatment. Objective: To identify liver involvement during the maintenance phase of ALL in children attending an outpatient service in Barranquilla (Atl., Colombia). Methodology: This was an explanatory, inferential study with an applied purpose and a longitudinal temporal scope, involving retrospective data review. It used ordinal qualitative measurements and was conducted in the outpatient service of a healthcare provider institution (IPS), located in Barranquilla, Atlántico, from January 2020 to November 2024. The study population consisted of patients under 18 years old diagnosed with acute lymphoblastic leukemia who presented alterations in liver enzymes during the maintenance phase. Descriptive and inferential analyses were performed on this population. Results: Twelve patients were included, with a mean age of 10.25 ± 3.62 years, significantly higher in males than in females (p = 0.034). Sixty-seven percent of the patients belonged to socioeconomic strata 1 and 2, and most (90%) had no significant clinical findings at baseline. During the maintenance phase, a progressive decline in normal TGO (Glutamic Oxalacetic Transaminase) and TGP (Glutamate Pyruvate Transaminase) levels was observed, accompanied by an increase in elevated levels (>1x upper limit of normal (ULN), >3xULN, >5xULN), although these changes were not statistically significant (TGO: p = 0.6; TGP: p = 0.09). Additionally, white blood cell counts decreased significantly between the beginning and end of the maintenance phase (p = 0.014). Regarding treatment, more than 50% of the patients received suboptimal doses of both 6-mercaptopurine and methotrexate. Although transaminase levels >5xULN were more frequent in patients receiving doses above the optimal range, no statistically significant differences were found (6-mercaptopurine: TGO p = 0.370, TGP p = 0.325; methotrexate: TGO p = 0.634, TGP p = 0.753). Conclusion: With the results we can conclude that there is a predominance of females in ALL in maintenance, that women have an earlier age of onset than men, the elevation of liver enzymes was related to the increase in the doses of chemotherapeutic drugs during the maintenance phase however is not statistically significant. Nevertheless, it is highlighted that 30% of patients begin the maintenance phase with elevated transaminases, which is why new studies aimed at this area are proposed.
Acute Lymphoblastic Leukemia (ALL) results from impaired cellular differentiation, increased proliferation, decreased apoptosis, and enhanced self-renewal, maintaining the presence of leukemic clones. In general, the BFM (Berlin-Frankfurt-Münster) protocols are used to treat leukemia in Latin America. This protocol consists of three phases: induction, consolidation, and maintenance. During these phases, patients may experience adverse effects such as hyperbilirubinemia and elevated transaminase levels due to the hepatotoxic effects of the drugs used in the treatment. Objective: To identify liver involvement during the maintenance phase of ALL in children attending an outpatient service in Barranquilla (Atl., Colombia). Methodology: This was an explanatory, inferential study with an applied purpose and a longitudinal temporal scope, involving retrospective data review. It used ordinal qualitative measurements and was conducted in the outpatient service of a healthcare provider institution (IPS), located in Barranquilla, Atlántico, from January 2020 to November 2024. The study population consisted of patients under 18 years old diagnosed with acute lymphoblastic leukemia who presented alterations in liver enzymes during the maintenance phase. Descriptive and inferential analyses were performed on this population. Results: Twelve patients were included, with a mean age of 10.25 ± 3.62 years, significantly higher in males than in females (p = 0.034). Sixty-seven percent of the patients belonged to socioeconomic strata 1 and 2, and most (90%) had no significant clinical findings at baseline. During the maintenance phase, a progressive decline in normal TGO (Glutamic Oxalacetic Transaminase) and TGP (Glutamate Pyruvate Transaminase) levels was observed, accompanied by an increase in elevated levels (>1x upper limit of normal (ULN), >3xULN, >5xULN), although these changes were not statistically significant (TGO: p = 0.6; TGP: p = 0.09). Additionally, white blood cell counts decreased significantly between the beginning and end of the maintenance phase (p = 0.014). Regarding treatment, more than 50% of the patients received suboptimal doses of both 6-mercaptopurine and methotrexate. Although transaminase levels >5xULN were more frequent in patients receiving doses above the optimal range, no statistically significant differences were found (6-mercaptopurine: TGO p = 0.370, TGP p = 0.325; methotrexate: TGO p = 0.634, TGP p = 0.753). Conclusion: With the results we can conclude that there is a predominance of females in ALL in maintenance, that women have an earlier age of onset than men, the elevation of liver enzymes was related to the increase in the doses of chemotherapeutic drugs during the maintenance phase however is not statistically significant. Nevertheless, it is highlighted that 30% of patients begin the maintenance phase with elevated transaminases, which is why new studies aimed at this area are proposed.
Descripción
Palabras clave
Leucemia, Trastorno hepático, Mantenimiento, Recurrencia, Pediátrica