Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia.
Pediatr Blood Cancer
; 56(4): 551-9, 2011 Apr.
Article
em En
| MEDLINE
| ID: mdl-21298739
ABSTRACT
BACKGROUND:
In spite of major improvements in the cure rate of childhood acute lymphoblastic leukaemia (ALL), 2-4% of patients still die from treatment related complications. PROCEDURE We investigated the pattern of treatment related deaths (TRDs) and possible risk factors in the NOPHO ALL-92 and ALL-2000 protocols. Fifty-five TRDs were identified among the 1,645 ALL-92 patients and 33 among the 1,090 ALL-2000 patients.RESULTS:
There was no significant difference in the incidence of TRDs between the two protocols (3.4% vs. 3.2%). Five patients died before initiation of therapy (0.2%), and the overall subsequent risk of induction death and death in first complete remission (CR1) was 1.2% and 1.8%, respectively. Infections were the major cause of death comprising 72% of all cases including 9 deaths from Pseudomonas aeruginosa and 11 deaths from fungal infections. Other causes of death included bleeding or thrombosis (eight patients), tumour burden related toxicities (seven patients) and organ toxicity (seven patients). Female gender (hazard ratio (HR) 2.2, 95% confidence interval (95% CI) 1.4-3.4), high white blood cell count (≥ 200 × 10(9) /L) at diagnosis (HR 3.5, 95% CI 1.7-7.1), T-cell disease (HR 1.9, 95% CI 1.01-3.7), Down syndrome (HR 7.3, 95% CI 3.6-14.9) and haematopoietic stem cell transplantation in CR1 (HR 8.0, 95% CI 3.3-19.5) were identified as independent risk factors for TRD.CONCLUSION:
Several TRDs were potentially preventable and future efforts should be directed towards patients at risk.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Leucemia-Linfoma Linfoblástico de Células Precursoras
Tipo de estudo:
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Pediatr Blood Cancer
Assunto da revista:
HEMATOLOGIA
/
NEOPLASIAS
/
PEDIATRIA
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Noruega