The Risk Factors and Outcomes of Neutropenic Colitis in Acute Lymphoblastic Leukemia During Chemotherapy

Abstract

Objective: To evaluate the risk factors and outcomes of neutropenia colitis in acute lymphoblastic leukemia (ALL) during chemotherapy.

Methodology: This prospective observational study was conducted from June to December 2024 at the Pediatric Hematology and Oncology unit of Indus Hospital & Health Network, Karachi. Children aged 1–16 years with ALL on active chemotherapy presenting with neutropenia (ANC <1500/?L), fever, abdominal symptoms, or hypoalbuminemia and radiologic gut wall thickening were enrolled. Patients were assessed demographic and clinical characteristics, mortality and risk factors. Data were collected via structured proforma and analysis was done by SPSS version 26.

Results: Overall mean age of 64 patients 7.15?±?1.19 years, and male predominance (67%). Out of all, 58% patients were classified as high-risk and 23% as standard-risk. Majority of patients (69%) occurred during the induction phase of chemotherapy, followed by delayed intensification (13%) and consolidation (10%) phases. Among 31% cases the blood cultures were positive, with E. coli being the most commonly isolated organism (25%). Overall mortality rate was 11%. Additionally, high-risk leukemia, signs of severe gastrointestinal involvement like blood in stool and increased gut wall thickness, and the presence of systemic infection, were observed to be predictor of mortality (p = >0.05).

Conclusion: The neutropenic colitis during chemotherapy in ALL carries a significant risk of the mortality. The cases with more aggressive disease, involvement of severe gastrointestinal conditions, or systemic infectious condition are at highest risk of adverse outcomes.