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Background: Acute Myeloid Leukemia (AML) contributes to about 20% of leukemia. Most of the AML patients suffer from infection. Objective: To evaluate the rate of infection, type and site of infection, organisms responsible for infection and to assess antibiotic sensitivity pattern and infection related mortality in AML. Material & Methods: Newly diagnosed AML patients aged between 1-18 years, admitted to receive induction chemotherapy were enrolled. They received induction of chemotherapy according to Modified MRC’ 12 in our department. Patient was on followup throughout the induction period and all the infectious complication occurred during this period were analyzed. Result: A total of 38 episodes of infection developed in 34 patients in both cycles of induction (1.12 episodes/ patient). Among the total 38 episodes of infection, fever was the commonest clinical presentation. In both chemotherapy cycles, 7(18.4%) episodes of infection were culture positive. A total of 9 organisms were isolated of which most of them was gram-negative. Fever without focus was found in 15(39.5%) episodes. Profound neutropenia was present in 15(39.47%) episodes and profound neutropenic episodes were found to be culture positive in 5(71.4%) cases. About 6(17.5%) patients died during 1st cycle of induction. Conclusion: Among children with AML, profound neutropenic cases had high susceptibility to culture positive infection. Further prospective study is needed to identify means to prevent infectious complication of AML patients receiving induction chemotherapy particularly in those with profound neutropenia. BANGLADESH J CHILD HEALTH 2021; VOL 45 (3) : 134-140

Background: Seizure is one of the most common CNS complications among patients receiving chemotherapy for acute lymphoblastic leukemia (ALL). Seizures are seen in 8-13% of patients with ALL. Most seizure occurs during the induction and consolidation phases of treatment. However, not much is known about the risk factors of these seizure. Materials & Method: This prospective observational study was conducted in the department of Pediatric Hematology and Oncology, BSMMU. One hundred and five newly diagnosed admitted children with ALL aged >1 year to

Background: Non-Hodgkin Lymphoma (NHL) is the third most common childhood malignancy. With histopathology based intensive chemotherapy and CNS-directed therapy, survival can reach more than 80%. Objective: The study was conducted to observe the clinico-pathological findings of NHL in Bangladeshi children. Methods: A prospective observational study was conducted in the Paediatric Haematology and Oncology Department of BSMMU from June 2012 to December 2012. Newly diagnosed NHL patients were included in the study. Patient’s initial clinical presentations, time interval from onset of symptoms to diagnosis were recorded. Diagnostic and staging workups were done by CBC, biochemistry, radio-imaging, histopathology (FNAC/excision biopsy), serous fluids/CSF cytology (cytospin), and bone marrow aspiration. Result: Among the 34 patients, BL had preponderance (n=23, 68%) then LL. Median age was 7.6 years. Male: female ratio was 2.1:1. Delayed diagnosis was found in 59% patient. Primary sites were abdomen (65%), thorax (32%), and head-neck (3%). At initial presentation, 83% patients of Burkitt NHL and 100% Lymphoblastic NHL patients came with advanced disease. Bone marrow involvement was found in 23.6% patients and 12% had CNS involvement at their presentation. Irrespective to histology, most common stage was stage-III, which was 53% and then stage-IV was 35%. Median LDH was 1719 U/L. Patient with abdominal variety of NHL came with abdominal complaint like pain (66%), distension (65%), ascites (48%), mass like hepatomegaly (39%), splenomegaly (26%), intussusceptions (8%), testicular involvement (4%). B symptoms were commonly found in 74% patient. Pallor (82%), anorexia, nausea & vomiting (48%), oedema (25%), peripheral lymphadenopathy (49%) were also noticed. In case of thoracic variety of NHL, most common presentation was respiratory distress (90%), superior mediastinal syndrome (SMS) (45%), with high incidence of B symptoms (90%), peripheral lymphadenopathy (72%) with other respiratory finding like chest bulging, mediastinal mass, pleural effusion was also found. Conclusions: About 59% childhood NHL patients tend to present with delayed diagnosis and 88% with advanced disease. Burkitt NHL is the commonest childhood lymphoma, mostly presented with abdominal complaint. Thoracic variety is mostly Lymphoblastic lymphoma. Histopathological findings following excisional biopsy is the most significant and confirmatory for diagnosis. Serum LDH were found significantly high level in both varieties. DS (Child) H J 2021; 37(1): 21-27

Pediatric acute promyelocytic leukemia (APL) is one of the most curable subtypes of acute myeloid leukemia of childhood. But it may have many early complications, especially in developing countries. This study aims to describe the outcome and complications of pediatric APL patients in Bangladesh. This prospective observational study was conducted in the pediatric hematology and oncology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to March 2019. In this study, PML:RAR-α (Promyelocytic leukemia-retinoic acid receptor-α) positive APL cases were included and observed while being treated with risk-directed ATRA (All-trans-retinoic acid) based chemotherapy. Among twenty PML:RAR-α positive APL cases, 13 children were in the high risk group and hemorrhagic manifestations were present in 95% of patients. Post-induction remission was achieved in 85% of the patients. 3-year overall survival was 70% (45-85% with 95% confidence interval). There was no refractory disease or relapses. Neutropenic sepsis was the most common complication and also the most common cause of mortality. In Bangladesh, the 3-year overall survival of pediatric APL is 70% (45-85% with 95% CI). Post-chemotherapy neutropenic sepsis is the most common complication and also the most common cause of mortality in this potentially curable malignancy in Bangladesh.

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition and weight lost are common and are due to verity of mechanism involving the tumor, the host response to the tumor such as infection and pharmacokinetics of chemotherapeutic drugs. Objective: To evaluate and compare the nutritional status of children with ALL at diagnosis and after completion of induction therapy. Methodology: This prospective observational study included 60 children newly diagnosed as ALL, aged 2-15 years, over a period from April 2012 to September 2012 in the Department of Pediatric Hematology and Oncology, BSMMU. The anthropometric measurements and serum albumin level were taken. Anthropometric indices are calculated by NCHS (WHO-2000) and classified as Z score. Children

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in patients with haematolgical malignancies. Factors that appear to be associated with IFIs in both children and adults in this severely immunosuppressed population are the underlying malignancies, presence of profound and long lasting neutropenia, high intensity of the therapeutic regimens, hematopoietic stem cell transplantation and previous antibiotic therapy. In patients with hematological malignancy most invasive fungal infections are caused by Candida and Aspergillous species. Though the incidence of IFI in adult may be as high as 30 % and the mortality up to 50 %, the true incidence in children and its outcome are more difficult to assess because of the growing trends towards more invasive chemotherapeutic regimens, the development and introduction of new antifungal drugs and prophylactic antifungal strategies and difference in design and patient populations among the various studies. In general the incidence rate in children appears to be lower than in adults. The diagnosis are based on the basis of microbiological and radioimagings with the criteria defined by the EORTC/MSG. Caspofungin, Liposomal amphotericin B and Voriconazole are often the first line empirical antifungal agents BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 34-40

Background: Fever in severe chemotherapy induced neutropenic patients is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimen. Objective: The aim of this study is identification of risk factors of fever in neutropenic children with acute lymphoblastic leukemia. Methodology: This observational study was carried out in the department of pediatric haematology and oncology department during the period of 1st February 2013 to 31st January 2014. Patients detailed history and behavioral pattern regarding the supportive management (neutropenic diet, use of acriflavine solution, nystatin oral solution, mouth wash with povidone iodine), total duration of hospital stay, duration of neutropenia, number of attendants during hospital stay were recorded. Blood, urine and wound swab culture was done. Result: Out of 40 patients most of the studied child were in induction phase of therapy. The mean hospital stay was 8.56±6.75 days and mean number of attendants with each patient was 2.02±0.65. Majority of the patient were on neutropenic diet and freshly cooked food (87.5%). This study shows a large portion (52.5%) of the studied population did not use acriflavine as per advice. It also revealed majority of the child did not use povidone iodine mouth wash (52.5%) and nystatin (47.5%). as per advice. A total of 10 patients (25%) revealed growth of pathogens. Among them blood culture was positive in 4 patients, urine culture was positive in 3 patients and wound swab culture was positive in 3 patients. This study showed that major portion (65%) of the febrile neutropenic child suffered from malnutrition. Conclusion: This study showed that majority of the patient did not properly follow the advice regarding behavioral and supportive management. Duration of hospital stay and number of attendants were also high. Malnutrition was present in a large portion of the child.

Background: Haematological malignancies comprise 82% of all malignancies in children at the department of Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh; Gastro-intestinal infections were the leading causes of infection in paediatric oncology patients. Objectives: This study was conducted to see the type of enteropathogens in stool samples during diarrhoeal episode in children with haematological malignancy. Methods: This observational study was conducted from April 2012 through March 2013 at BSMMU, Bangladesh. A total of 58 diarrhoeal episodes experienced by 51 children of various types of haematological malignancies were included in the study. Faecal samples from studied children were sent to Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), laboratory to do aerobic culture for common bacteria; Enzyme Immunoassay (EIA) for Clostridium difficile and multiplex real-time polymerase chain reaction (PCR) for parasitic infection. Results: Among the total 58 diarrhoeal episodes, potential pathogenic bacteria were isolated from only 5.17% sample. Faecal samples from 22.41% episodes were found positive for GDH antigen for Clostridium difficile; none of the focal samples were positive for toxin A and/ or B. Several different parasites were identified from 70.37% samples and most frequently identified protozoa was Giardia lamblia in 68.52%. Conclusion: The study found 22.41% colonization rate with Clostridium difficile but none was toxigenic. Parasitic infections were seen more frequently in children with haematological malignancy. The study also found significant association of severe neutropenia with GDH positive diarrhoeal episodes.

Background: Hepatoblastoma is a rare malignant liver tumour that occurs almost exclusively in childhood. Although surgical resection is the foundation of curative therapy, with the use of effective neoadjuvant and adjuvant chemotherapy the 5 years overall survival of patient with hepatoblastoma had recently reached up to 80% to 90 %. But the frequency and severity of haematological toxicity is one of the major concerns of intensive chemotherapy. Objective: To evaluate the frequency and severity of haematological toxicities following treatment of childhood hepatoblastoma with two different regimens of multi-agent chemotherapy. Methodology: This was a comparative observational study conducted at Bangabandhu Sheikh Mujib Medical university in 24 childhood hepatoblastoma patients who received either cisplatin/carboplatin /doxorubicin (Group A; n=14) or cisplatin/ vincristine/5- fluorouracil (Group B; n= 10) to between March 2010 and July 2014. Results: Grade 3 or 4 anaemia and thrombocytopenia, and Grade 4 neutropenia were observed in 64.3% vs 60%, 35.7% vs 20% and 57.1% vs 20% respectively in group A and Group B. Febrile neutropenia occurred in 100% vs 70% and septicaemia developed in 92.9% vs 70%. Red cell concentrates and Platelet transfusions were required in 35.7% vs 50% and 14.3% vs 10% respectively in two groups. Deaths due to haematological toxicities occurred in 21.4% in Group A and 21% in Group B. Conclusion: We found similar toxicity profiles for two chemotherapy regimens except for higher rates of febrile neutropenia and septicaemia in patients treated with cisplatin/carboplatin /doxorubicin compared to cisplatin/ vincristine/5- fluorouracil.

Background: Acute lymphoblastic leukemia (ALL) is the commonest malignancies in childhood. Common obstacle in the treatment of ALL is febrile neutropenia and its complications. Objectives: To identify bacteria causing infection, their isolation rate and antibacterial sensitivity pattern in hospitalized febrile neutropenic children with ALL in different cycle of chemotherapy. Methodology: This observational study conducted in 2014 - 2015 in the department of paediatric haematology and oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Sixty febrile neutropenic episodes from 52 diagnosed cases of ALL aged 0 to18 years were included. Complete blood count, blood culture, urine microscopy and culture, serum alanine aminotransferase, serum creatinine were done in every patient. X-ray chest, stool microscopy and culture, pus, wound, throat and aural swab for culture & sensitivity were done in selective patient. Results: Bacterial infection was confirmed by culture in 15 (25%) episodes from 60 febrile neutropenic episodes. Fifteen (25%) organisms were isolated from the study subjects from sample of blood (60%), pus (13.3%), aural swab (13.3%), wound swab (6.7%) and throat swab (6.7%) respectively. All isolates were gram negative. The organism isolated were Klebsiella spp. 5 (33.31%), E. coli 4 (26.7%), Acinetobacter 3 (20%), Pseudomonas 2 (13.3%) and only one (6.7%) Enterobacter species. All the isolates of the Klebsiella spp., E. coli and Acinetobacter spp. were resistant to amoxicillin. All isolated E. coli were resistant to cotrimoxazole, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin, Acinetobacter spp. Isolated were 100% sensitive to imipenem, colistin sulphate & piperacillin-tazobactam and resistant to cotrimoxazole and cephradine. All Pseudomonas spp. showed 100% sensitivity to imipenem, amikacin, ciprofloxacin & colistin and resistances to ceftazidime. Conclusion: The species of Klebsiella were the predominant causative bacterial agent followed by Escherichia coli, Acinetobacter spp, pseudomonas spp. and Enterobacter spp. They showed resistance to commonly prescribed antibiotics ceftazidime, gentamicin, ceftriaxone & ciprofloxacin and sensitive to imipenem, colistin-sulphate & piperacillin-tazobactam.

Histoplasma capsulatum is a dimorphic fungus, which primarily causes a pulmonary disease. It is found throughout the world with the soil being the environmental reservoir. In infants and toddlers, disseminated histoplasmosis is the commonest presentation. In this age group, 60-80% patients has acute disseminated progressive disease. Disseminated histoplasmosis may also cause bone involvement with osteolytic lesion. Here, we have described a rare and unusual disseminated histoplasmosis, a 3 and half year old boy from Bangladesh with multiple abscess like soft tissue lesions, along with multiple osteolytic bone lesions.Bangladesh J Child Health 2018; VOL 42 (2) :94-97

not availableNorthern International Medical College Journal Vol.9(1) July 2017: 248-251

Background: Treatment of Acute Lymphoblastic Leukemia (ALL) is mainly chemotherapy based. In the past outcome of treatment with polychemotherapy was dissatisfying. Recently success have improved as risk based polychemotherapy has been employed. Therefore in modern approach of the treatment of ALL of children assessment of risk factors has become a key issue. It has been observed in the studies abroad that response to prechemotherapy corticosteroid could be a clue to the good response to chemotherapyObjectives: The objectives of this study were to see the effects of dexamethasone on initial tumor load and to observe the relationship of the effects of prechemotherapy dexamethasone on tumor burden and the outcome of Induction of Remission.Materials and Methods: This was a prospective study carried out from January 2004 to June 2005 in the Department of Pediatric Hematology and Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU). All the cases between one to fourteen years of either genders were enrolled into the study after their confirmation as ALL. Tumor load was assessed before the beginning of prechemotherapy dexamethasone and after the day 7 of prechemotherapy dexamethasone. After reassessment of tumor load, polychemotherapy of Induction of Remission was begun. Bone marrow study was performed every seven days after starting Induction chemotherapy until the bone marrow remission was achieved. Then the effect of prechemotherapy dexamethasone on tumor load was compared with the outcome of Induction polychemotherapy. The results were analyzed maintaining standard procedure with SPSS version 10.0.Results: A total of 40 patients were enrolled into the study. Among them 21 were male and nineteen were female. Thirty were FAB L1 and ten were L2 morphologically. Reduction of tumor load was evident as estimated by peripheral blast count together with hepatic and splenic mass. Response to prechemotherapy dexamethasone was good in 21 out of 28 patients with the WBC count below 50x109/L as compared to only 4 out of 12 with the WBC count >50x109/L (P=0.013). Similarly, 21 in 24 in the group 25x109/L Initial Blast Cell count (P=0.000). Among the 25 good responders to prechemotherapy dexamethasone 24 went into remission within 7 days of induction and among the 15 poor responders only 6 went into remission within 7 days of induction (P=0.000).Conclusion: Response to pre-chemotherapy dexamethasone could be a strong guide to predict the outcome of induction chemotherapy and help in risk stratification of childhood Acute Lymphoblastic Leukemia.Bangladesh J Child Health 2016; VOL 40 (2) :79-84

Epistaxis in children is one of the important presenting symptoms for attending emergency department in paediatric patients. Recurrent epistaxis is common in children. Although epistaxis in children usually occurred due to different benign conditions, it may be one of the important presenting symptoms of some inherited bleeding disorder. Whereas most bleeding disorders can be diagnosed through different standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. In this article we describe one case report of platelet function disorders on Glanzmann’s thrombasthenia (GT). Our patient was a 10-year old girl who presented to us with history of recurrent severe epistaxis. She had a bruise on her abdomen and many scattered petechiae in different parts of the body. Her previous investigations revealed no demonstrable haemostatic anomalies. After performing platelet aggregation test, she was diagnosed as GT.

not availableBangladesh J Child Health 2016; VOL 40 (3) :132-134

Background: Leukemia is characterized by persistent and enormous proliferation of immature white blood cell. Without CNS-directed therapy relapses originating from CNS are up to 75%. The presence of overt CNS disease at initial presentation (cranial nerve palsies) negatively affects the EFS of children with ALL. Early intensive intrathecal and systemic therapy is now more successful in treating and preventing CNS leukemia and reducing the cumulative risk for all relapses with CNS involvement of 4.4%, even in patients whose leukemic blast cells is iatrogenically introduced into the cerebrospinal fluid by traumatic lumbar puncture. Methods: 546 patients were enrolled based on initial central nervous system (CNS) status: CNS1 (CNS negative, n=445), CNS2 (≤5 WBC/HPF CSF with blasts, n=35), CNS3 (CNS positive, n=18), TLP+ (TLP with blasts, n=38) and TLP- (TLP without blasts, n=10). Lumbar punctures (LP) were performed at initial presentation and again at initial intrathecal (IT) therapy. Effect of traumatic lumbar puncture (TLP) were evaluated and followed-up for three years. Two extra doses of intrathecal methotrexate (IT MTX) were given with CNS2 and TLP+ status of patients. Additional IT MTX and cranial irradiation (CI) 24 Gy units were given to children of CNS3 status. Results: Children with CNS2, CNS3 and TLP+ status found with unfavorable characteristics (high WBC count, raised serum LDH, hepatosplenomegaly, lymphadenopathy, immunological status, response to therapy and risk group etc.). Event free survival (EFS) with one contaminated TLP++ with blasts in CSF was worse than that of without any contamination (p=0.001). EFS with two consecutive contaminated TLP++ in CSF sample found to have significantly poor outcome (5 years EFS=50 ±7%). Cox regression analysis showed hazards of adverse effects 2.39 times more common with TLP++ status than those with CNS1 (95% confidence interval (CI), 1.36-4.20; p=0.003, Cumulative incidence (CI) with TLP++ status was higher than those with CNS1 (5 years: 32± 10 and 11±2 respectively). TLP+ and CNS3 status had significant prognostic value: risk ratio (RR) = 2.39, 95% CI, 1.4 to 3.6; p=0.0005; TLP+: RR=1.5, 95% CI, 1.02 to 2.20; p= 0.04. Overall 5-year EFS were found 75%. EFS with CNS1 and CNS2 status were 82% and for the TLP-status was 85%. EFS for CNS3 status was 52% and suffers from more systemic involvement. CI of relapses with CNS involvement was higher compared with CNS1 status (0.13 versus 0.06). Children with TLP+ status had significant decreased EFS (75%, p=0.003) due to increased incidence of CNS relapses. Children with CNS2 had same prognosis as that with CNS1 status, whereas EFS of TLP+ status was inferior to CNS1 status but was superior to CNS3 status (p=0.001). EFS with two consecutive TLP++ status contaminated CSF sample was particularly poor. Conclusion: Contamination of CSF samples with circulating leukemic blasts during diagnostic lumbar puncture, an additional IT MTX is indicated which prevent adverse effect and outcome of newly diagnosed ALL. For improved treatment outcome every attempt should be made to prevent TLP. Occurrence of this adversely affects the quality of life, making the need of additional IT MTX therapy. Methods: 546 patients were enrolled based on initial central nervous system (CNS) status: CNS1 (CNS negative, n=445), CNS2 (≤5 WBC/HPF CSF with blasts, n=35), CNS3 (CNS positive, n=18), TLP+ (TLP with blasts, n=38) and TLP- (TLP without blasts, n=10). Lumbar punctures (LP) were performed at initial presentation and again at initial intrathecal (IT) therapy. Effect of traumatic lumbar puncture (TLP) were evaluated and followed-up for three years. Two extra doses of intrathecal methotrexate (IT MTX) were given with CNS2 and TLP+ status of patients. Additional IT MTX and cranial irradiation (CI) 24 Gy units were given to children of CNS3 status. Results: Children with CNS2, CNS3 and TLP+ status found with unfavorable characteristics (high WBC count, raised serum LDH, hepatosplenomegaly, lymphadenopathy, immunological status, response to therapy and risk group etc.). Event free survival (EFS) with one contaminated TLP++ with blasts in CSF was worse than that of without any contamination (p=0.001). EFS with two consecutive contaminated TLP++ in CSF sample found to have significantly poor outcome (5 years EFS=50 ±7%). Cox regression analysis showed hazards of adverse effects 2.39 times more common with TLP++ status than those with CNS1 (95% confidence interval (CI), 1.36-4.20; p=0.003, Cumulative incidence (CI) with TLP++ status was higher than those with CNS1 (5 years: 32± 10 and 11±2 respectively). TLP+ and CNS3 status had significant prognostic value: risk ratio (RR) = 2.39, 95% CI, 1.4 to 3.6; p=0.0005; TLP+: RR=1.5, 95% CI, 1.02 to 2.20; p= 0.04. Overall 5-year EFS were found 75%. EFS with CNS1 and CNS2 status were 82% and for the TLP-status was 85%. EFS for CNS3 status was 52% and suffers from more systemic involvement. CI of relapses with CNS involvement was higher compared with CNS1 status (0.13 versus 0.06). Children with TLP+ status had significant decreased EFS (75%, p=0.003) due to increased incidence of CNS relapses. Children with CNS2 had same prognosis as that with CNS1 status, whereas EFS of TLP+ status was inferior to CNS1 status but was superior to CNS3 status (p=0.001). EFS with two consecutive TLP++ status contaminated CSF sample was particularly poor. Conclusion: Contamination of CSF samples with circulating leukemic blasts during diagnostic lumbar puncture, an additional IT MTX is indicated which prevent adverse effect and outcome of newly diagnosed ALL. For improved treatment outcome every attempt should be made to prevent TLP. Occurrence of this adversely affects the quality of life, making the need of additional IT MTX therapy. Objectives: The study was designed to determine the prognostic significance of leukemic blasts cell infiltration or traumatic lumbar puncture (TLP) in cerebrospinal fluid (CSF) of newly diagnosed children with acute lymphoblastic leukemia (ALL).Background: Leukemia is characterized by persistent and enormous proliferation of immature white blood cell. Without CNS-directed therapy relapses originating from CNS are up to 75%. The presence of overt CNS disease at initial presentation (cranial nerve palsies) negatively affects the EFS of children with ALL. Early intensive intrathecal and systemic therapy is now more successful in treating and preventing CNS leukemia and reducing the cumulative risk for all relapses with CNS involvement of 4.4%, even in patients whose leukemic blast cells is iatrogenically introduced into the cerebrospinal fluid by traumatic lumbar puncture. Objectives: The study was designed to determine the prognostic significance of leukemic blasts cell infiltration or traumatic lumbar puncture (TLP) in cerebrospinal fluid (CSF) of newly diagnosed children with acute lymphoblastic leukemia (ALL).

Introduction : Haemophilias are the most common inherited coagulation disorders transmitted by X- linked recessive fashion affecting the males and females are the carriers of the disease. Haemophilias are distributed worldwide and have heterogeneous presentation depending upon its severity starting from neonatal period. Knowledge of spectrum of presentation of haemophilia helps in early diagnosis and planning of management. Objectives : To observe the clinical presentation of haemophilia in children Methodology : This observational study was carried out in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University for a period of one year from 1 st July 2007 to 30 th June 2008. Clinical profile of 50 diagnosed cases of haemophilia

DOI: http://dx.doi.org/10.3329/bjch.v37i1.15349 BANGLADESH J CHILD HEALTH 2013; VOL 37 (1) : 27-40

DOI: http://dx.doi.org/10.3329/bjch.v36i3.14273 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 111-114

Introduction: Nausea and vomiting are the most important side effects of cytotoxic chemotherapy and it is reported by the patients who receive chemotherapy for malignancies. Ondansetron and granisetron (5 HT3 receptor antagonists) are effective compounds with relatively less toxicity to prevent nausea and vomiting induced by high and moderate emitogenic chemotherapy. Objective: This study was carried out to evaluate the efficacy of granisetron and ondansetron preventing chemotherapy induced nausea and vomiting (CINV). Methods: In this randomized double blind trial 60 children (4-11 years) with acute lymphoblastic leukemia (ALL) who received high dose methotrexate (HDMTX-2.5gm/ m2). Each patients received either ondansetron 4 mg or granisetron 1mg (n=30) orally half an hour before HDMTX. Nausea and vomiting were assessed based on ‘’modified Morrow Assessment of Nausea and Emesis’’ (MANE) scale for application to the children. Results: Complete response of granisetron significantly differed from ondansetron from day 2-4 (delayed emesis) (p=0.028).Complete response to acute CINV were 90% in granisetron and 70% in ondansetron treated children (p=0.053), which was not statistically significant. No Child of granisetron group required additional dose but 16.7% children of ondanseton group required additional dose on the first day (p=0.05). Episodes of nausea found in ondansetron treated children 36.7% and in granisetron group 3.3% on day four (p=0.001). Maximum episodes of vomiting found in ondansetron treated children 33.3% and minimum episodes in granisetron group 3.3% on day 2 (p=0.003). In few cases adverse effects (headache, constipation, abdominal pain, loose motion and decreased appetite) were observed in both group of patients (p=0.999). Only in 3.3% cases anticipatory nausea and vomiting had observed. Conclusion: In conclusion, single dose oral granisetron (1mg) is superior to oral ondansetron (4mg) preventing chemotherapy induced emesis in children with ALL receiving HDMTX therapy. DOI: http://dx.doi.org/10.3329/bjch.v36i3.14272 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 115-121