Death during induction therapy and first remission of acute leukemia in childhood

Abstract

BACKGROUND Despite improvements in supportive care, death due to treatment toxicity remains a significant problem for children treated for acute leukemia. METHODS To determine the causes of and risk factors for death unrelated to refractory leukemia, to disease recurrence, or to second malignancy, the authors reviewed the records of 1011 patients with acute lymphoblastic leukemia (ALL) and 260 patients with acute myeloid leukemia (AML) treated between 1984 and 1999 and between 1983 and 2002, respectively, at St. Jude Children's Research Hospital (Memphis, TN). Data for patients who underwent stem cell transplantation were censored at the time of transplantation. RESULTS For patients with ALL, the estimated 10‐year cumulative incidence of death was 2.9% ± 5.3%. Age was the only predictor of death. Patients with ALL 1–9 years old had a significantly lower risk of death than did younger or older patients (P = 0.002). For patients with AML, the estimated 5‐year cumulative incidence of death was 7.6% ± 1.9%. Increasing age and increasing leukocyte count were significantly associated with increased risk of death. For patients with ALL and with AML, the incidence of death remained relatively constant during the time periods studied. Infection was the most common cause of death. CONCLUSIONS In the current study, the authors determined that children ≥ 10 years of age are at increased risk of death during therapy for ALL and AML. Cancer 2004. © 2004 American Cancer Society.

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

“…The ALL-BFM Study Group reported similar death rates for their studies ALL-BFM-86 and À90, 17 as did other collaborative groups. 10,18,19 The MRC identified high initial WBC and DS as risk factors for treatmentrelated mortality, whereas in other series, age was the main prognostic factor. 10,19 The relatively low death rate due to infections in ALL patients might reflect the empiric use of broad spectrum antibiotics in case of neutropenic fever, as well as successful prevention of Pneumocystis carinii pneumonia.…”

“…10,18,19 The MRC identified high initial WBC and DS as risk factors for treatmentrelated mortality, whereas in other series, age was the main prognostic factor. 10,19 The relatively low death rate due to infections in ALL patients might reflect the empiric use of broad spectrum antibiotics in case of neutropenic fever, as well as successful prevention of Pneumocystis carinii pneumonia. 9,10 Some other cases of CRM may be readily preventable, such as accidental intrathecal vincristine administration.…”

Incidence and predictors of treatment-related mortality in paediatric acute leukaemia in El Salvador

“…Among patients with ALL in HICs, studies have identified gender, age, high white blood cell count, high-risk ALL, T-ALL, and Down's syndrome as TRM risk factors, although these have not been consistent (Wheeler et al, 1996;Rubnitz et al, 2004;Christensen et al, 2005;Slats et al, 2005). Conversely, Advani et al (1999) found that in the LIC of India, low haemoglobin, lymphadenopathy, and malnutrition were all associated with increased risk of TRM in ALL.…”

“…Although several studies have examined predictors of TRM in HICs (Wheeler et al, 1996;Riley et al, 1999;Creutzig et al, 2004;Rubnitz et al, 2004;Christensen et al, 2005;Slats et al, 2005), very few have looked at similar risk factors in LICs (Advani et al, 1999). Among patients with ALL in HICs, studies have identified gender, age, high white blood cell count, high-risk ALL, T-ALL, and Down's syndrome as TRM risk factors, although these have not been consistent (Wheeler et al, 1996;Rubnitz et al, 2004;Christensen et al, 2005;Slats et al, 2005).…”

“…In AML within HICs, female gender, age, high white blood cell count, low performance status at treatment initiation, M5 histology, and the central nervous system status have all been identified as increasing the risk for TRM, although again these findings have varied significantly from study to study (Riley et al, 1999;Creutzig et al, 2004;Rubnitz et al, 2004;Slats et al, 2005). A recent study examining children with AML enrolled on a Children's Cancer Group clinical trial found that age 416 years, non-white ethnicity, and underweight status were all significantly associated with infection-related mortality (Sung et al, 2007).…”