Hematotoxicity in acute lymphoblastic leukemia children who received 6-Mercaptopurine during maintenance therapy in Indonesia

This study aimed to determine factors affecting the occurrence of hematotoxicity in acute lymphoblastic leukemia (ALL) patients during maintenance phase therapy. This retrospective, observational study was conducted by analyzing the medical records of ALL patients undergoing 6-mercaptopurine (6MP)-based treatment (6MP, methotrexate, vincristine, and dexamethasone) during the maintenance phase at the Cipto Mangunkusumo Hospital, Indonesia, from January 2014 to December 2016. Ninety (89.1%) of ALL patients analyzed experienced hematotoxicity occurrence during the maintenance phase (anemia, 77.2%; neutropenia, 35.6%; and thrombocytopenia,26.7%). Most of the anemia and thrombocytopenia cases were grades 1-2, while the neutropenia cases were mostly grade 3-4. Bivariate analysis revealed no statistically significant differences in disease stratification, gender, body mass index, and serum albumin levels between patients with and without grade 3-4 neutropenia or between those with and without thrombocytopenia. Conversely, age, gender, and disease stratification were significantly different between those with and without anemia. In conclusions, ALL patients often experience hematotoxicity during maintenance phase therapy, especially those with grade 3-4 neutropenia. Anemia was more prevalent in males, in the younger age group, and in patients with standard risk stratification.