| Background: Chemotherapy drugs for the children with acute lymphocyte leukemia chemotherapeutics include vincristine, daunorubicin, asparaginase, cytarabine, prednisone, etc. While these drugs play the cytotoxic effect on the leukemia cells they have many side effects due to the injuries on the normal cells and tissues, which may affect the chemotherapy effect or interfere the chemotherapy process. Thus the assessment of chemotherapy should be based on not only the efficacy but also the toxicity of chemotherapy drugs. So it is particularly important to report and analyze the chemotherapy side effects accurately and objectively . The National Cancer Institute (NCI) published the Common terminology criteria for adverse events version 3.0(CTCAE v3.0) in 2003, to standardize and uniform the evaluation of chemotherapy side effects. This study will use this new system to evaluate the side effects of chemotherapy for children with ALL for the fist time.Objective: To discuss the side effects of chemotherapy for children with ALL, and by applying the CTCAE v3.0 system to evaluate the grade of these side effects occurred in children with ALL.Methods: By applying the CTCAE v3.0 to study retrospectively the side effects of the chemotherapy of children with ALL, who were treated in October 2004 to June 2007 in our centre. All of the children with ALL were treated by 04 programs; Statistical analysis was done by software SPSS 13.5 for Windows.Results: The bone marrow suppression caused by chemotherapy includes neutropenia, anemia, thrombocytopenia. The occurrence of neutropenia in four chemotherapy stages was93.2%,`91.8%,`41.2% and 58.8%, the occurrence of anemia was 100%,`100%,`67.6% and`97.1%, the occurrence of thrombocytopenia was 97.7%, 95.9%, 47.1% and 85.3%, there were significant differences between the four stages in all(P<0.05), but no significant differences between the induction and consolidation stages(P>0.05/6); By applying the CTCAE v3.0 to evaluate the bone marrow suppression, the results show that it was more serious in induction and consolidation stages. The ratio of 3～4 grade neutropenia in these two stages was 78% and 96%, the ratio of 3～4 grade anemia was 100.0% and 97.0%; the thrombocytopenia is more severe in consolidation stage, in which about 96.0% of the patient occurred 3～4 grade thrombocytopenia.The total infection occurrence associated with the chemotherapy was 57.6%, which was 79.5% in the induction stage and 65.3% in the consolidation stage. There was no statistically significant differences between these two stages (P=0.067). In the 118 cases of the infection, diarrhea occurred in 59.3% and pneumonia occurred in 28.0%. The overall fungal infection occurrence was 22.0% of the chemotherapy regimens. It was seen mostly in induction stage. Deep fungal infection occurred in 12 cases, and 5 cases of them had a clear etiological diagnosis.Chemotherapy-related deaths occurred in 8 cases, mainly occurred in the induction stage (87.5%), 7 cases of them died of infection caused by neutropenia, and 5 cases accompanied with fungal infection.Cardiac damage occurred in 17 cases, which occurred in induction stage mostly (83.2%). The cardiac damage was mainly for the increase in CK-MB and ECG abnormalities.The occurrence of liver damage in induction, consolidation, early Intensive VDLD and early Intensive EA stages was 78.4%, 18.4%m 17.6% and 0. The main forms of liver damage were hypoalbuminemia, transaminase increased and hyperbilirubinemia, and mostly was 1～2 grade damage. Hyperglycemia occurred in 12 cases, and mainly was 3～4 grade hyperglycemia(75%), the median glucose was 21.53mmol/L (6.21~59.55mmol/L).Conclusion:①Bone marrow suppression was common in children with acute lymphocyte leukemia treated by chemotherapy, and the grades were different between the four stages. Severe bone marrow suppression occurred mainly in induction and consolidation stages, and the thrombocytopenia was more severe in consolidation stage, in which we should pay more attention to prevent bleeding.②The infection occurrence of chemotherapy was more serious in induction and consolidation stages, which associated with the grade of neutropenia, the poor body condition and the economic condition. The diarrhea and pneumonia was the main form of infection. Fungal infections mainly occurred in induction stage, most of them were diagnosed by clinical experience, and few had a clear etiological diagnosis.③Chemotherapy-related deaths mainly occurred in the induction stage, the main cause of death was infection and bleeding caused by bone marrow suppression.④Myocardial damage also mainly occurred in the induction stage, it was related to the DNR, and without a dose-effect relationship. Liver damage occurred mainly in the induction stage, the common form was hypoalbuminemia, transaminase increased, which related to the inhibition of protein caused by L-Asp.
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