Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia

Abstract

SUMMARY Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤ 60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999–2012, we identified patients aged ≥ 15 years with AML who received inpatient treatment (N=6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25.3%, 1999–2000; 16.8%, 2011–2012) across all age groups, but was higher in older patients (6.9%, 15–39, 11.4%, 40–54, 18.6% 55–65, and 35.8%, > 65 years). Major bleeding (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3–1.9), liver failure (OR 1.9, 95% CI 1.1–3.1), renal failure (OR 2.4, 95% CI 2.0–2.9), respiratory failure (OR 7.6, 95% CI 6.2–9.3) and cardiac arrest (OR 15.8, 95% CI 8.7–28.6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0.5, 95% CI 0.4–0.6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality.

Acute liver failure due to liver parenchymal infiltration with acute myelogenous leukaemia in a patient with myelodysplastic syndrome

“…Hepatic parenchymal infiltration in acute myelogenous leukaemia (AML) has rarely been reported despite AML being one of the most common acute leukaemias 1. Previous literature suggested that if patients with AML develop acute liver failure, mortality rates are 1.9 times higher 2. We report a case of liver infiltration by AML resulting in acute liver failure which is uncommon to the best of our knowledge.…”

Acute myelogenous leukemia in adolescents and young adults

“…However, differences in outcomes of patients treated in pediatric versus adult trials are more pronounced for adolescent patients with ALL than for patients with AML even when chemotherapy intensity is generally higher in pediatric AML protocols than in adult protocols, and HSCT is given more restrictively (risk adapted) than that given for adults. AYA‐specific approaches can be influenced further by referring these patients to centers experienced in managing leukemia or centers participating in clinical trials for children or adults . Cooperation between pediatric and adult study groups is of utmost importance.…”

“…AYA-specific approaches can be influenced further by referring these patients to centers experienced in managing leukemia or centers participating in clinical trials for children or adults. 20,71 Cooperation between pediatric and adult study groups is of utmost importance. AYA patients need to be enrolled in clinical trials, and cross-study analyses comparing strategies for pediatric and adult patients are required.…”

Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute‐designated cancer centers in California

“…We previously observed that race/ethnicity, neighborhood socioeconomic status, marital status and location of care impacted early mortality in AML patients. 9 .…”

“…9 In this present study, we examine differences in sociodemographic and clinical characteristics of AML patients treated at NCI versus non-NCI-CCs. We also evaluate the impact of hospital type on early mortality while controlling for these differences and examine whether complications during initial therapy by location of care impact early mortality.…”