Problems of Radiation Medicine and Radiobiology

D. A. Bazyka¹, V. A. Zhovnir¹, K. M. Bruslova¹, L. O. Lyashenko¹, T. I. Pushkareva¹,
N. M. Tsvietkova¹, A. P. Rybalska¹, T. P. Gavrylenko³, V. G. Kondrashova¹, Zh. S. Yaroshenko¹,
L. O. Gonchar¹, I. V. Trychlіb¹, V. F. Kuzmenko¹, S. M. Iatsemyrskyi¹, V. D. Pismenniy²,
Y. M. Samson¹, O. M. Ivanova¹, T. O. Chernysh¹

¹State Institution «National Research Center for Radiation Medicine, Hematology and Oncology of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
²O. O. Bogomolets Memorial National Medical University, 13 Taras Shevchenko Blvd, Kyiv, 01024, Ukraine
³Consultative and Diagnostic Center #1 of Kyiv City Darnytsky district, 8D Trostianetska St., Kyiv, 02091, Ukraine

SERUM FERRITIN CONTENT AND INCIDENCE AND TYPE OF INFECTIOUS AND INFLAMMATORY COMPLICATIONS IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA, RESIDING IN RADIOLOGICALLY CONTAMINATED TERRITORIES OF UKRAINE AFTER THE ChNPP ACCIDENT

Objective. evaluation of the frequency and type of bacterial-fungal complications and outcome of acute lymphoblastic leukemia (ALL) taking into account the serum ferritin content in children, residing in radiologically contaminated territories (RCT) of Ukraine after the ChNPP accident.
Materials and methods. Pediatric ALL patients (n = 146), residing in RCT of Ukraine, were the study subjects within a survey period of 15 years. The ALL diagnosis and distribution of patients by the disease variants were held according to the FAB classification and results of immunophenotyping of the bone marrow blast cells. Chemotherapy (CT) was prescribed according to the Berlin-Frankfurt-Munster group (BFM) protocols. Patients were examined after the remission induction therapy. Incidence and type of the bacterial-fungal and toxic complications were assessed. The number of deaths was taken into account depending on the age, ALL variant and serum ferritin (SF) content. Radiation doses to the bone marrow were calculated for the entire period of stay in RCT after the accident. Processing of the obtained materials was carried out using the mathematical statistical methods (Student’s and Spearman’s correlation coefficients, χ² Pearson test).
Results. Study subjects were distributed according to the ALL variants, namely pro-B (n = 21, 14.4 %), «general» type (n = 97, 66.4 %), pre-B (n = 12, 8.2 %), and T-ALL (n = 16, 11.0 %). Three groups were formed taking into account the SF levels: Group I (n = 53) – SF up to 200 ng/ml, Group II (n = 49) – SF from 200 ng/ml to 500 ng/ml, Group III (n = 44) – SF above 500 ng/ml. The blood hemoglobin level and RBC count were decreased along the increase in SF content (p < 0.05). A direct correlation was found between the SF content and RBC average volume (r = 0.45; р < 0.05). Anemia was of a normocytic type. The lowest number of cases with iron overload was among the children with pre-B-HLL disease variant (1 out of 12). An inverse correlation was established between the transferrin concentration and average hemoglobin content in RBC (r = -0.6; р < 0.05). Sepsis and infections of the anal area were more often observed in the patients with SF level above 200 ng/ml. The course of pneumonia was complicated in case of SF level above 500 ng/ml. The oral cavity and intestinal mucositis did not depend on SF level. Incidence of the systemic toxic effects after chemotherapy was increased under SF level above 500 ng/ml. The number of deaths in children with SF levels above 500 ng/ml was almost doubled. Most of the deaths occurred in the patients with pro-B-ALL (15 out of 21) and T-ALL (8 out of 16) disease variants. Fewer children had died having the «common» ALL type (14 out of 97, 14.4 %). The number of deaths in case of pre-B-ALL variant not depended on SF levels. The «common» type and T-ALL patients having got iron overload died more often. The average radiation doses to the bone marrow were (4.9 ± 0.4) mSv and did not affect the remaining parameters.
Conclusions. Iron excess in the body affects the incidence and type of infectious complications both with the outcome of ALL in children, which requires timely diagnosis and preventive measures.
Key words: children; acute leukemia; infectious-fungal complications; chemotherapy; fatalities; radiation doses to bone marrow.

Problems of Radiation Medicine and Radiobiology.
2025;30:310-321. doi: 10.33145/2304-8336-2025-30-310-321

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