Hematopoietic Effects of Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukemia: A Systematic Review

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, and while chemotherapy has significantly improved survival, its myelosuppressive effects can severely impair hematopoiesis. This suppression contributes to cytopenias, increased infection risk, and treatment delays. Despite its clinical relevance, comprehensive evaluations of hematopoietic suppression and recovery in pediatric ALL patients remain limited. Method: This systematic review was registered in PROSPERO (CRD420251074627) and conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, ScienceDirect, and SpringerLink for studies published from 2020 to 2025 using keywords related to chemotherapy, hematopoiesis, and pediatric ALL. Inclusion criteria encompassed original studies reporting pre- or post-chemotherapy hematopoietic outcomes in pediatric ALL patients. Articles were screened through title, abstract, and full-text review, and relevant data were synthesized narratively. Result: From 909 articles initially identified, 13 studies met inclusion criteria. Chemotherapy, particularly during induction, consistently led to significant hematopoietic suppression, especially of neutrophils, erythrocytes, and platelets. Recovery was observed to be phase-dependent and lineage-specific, with early indicators such as reticulocyte count and immature platelet fraction (IPF) showing promise for monitoring marrow regeneration. Bone marrow cellularity correlated with peripheral counts, and hematopoietic stem cell transplantation (HSCT) in high-risk cases showed improved survival outcomes. Conclusion: Chemotherapy induces profound yet often reversible hematopoietic suppression in pediatric ALL. Early monitoring of hematopoietic markers and individualized supportive care are essential to reduce complications. Integration of marrow and peripheral parameters may enhance recovery assessment and guide clinical decision-making, particularly in high-risk or relapsed cases.