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Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia
Author(s) -
Lund Bendik,
Åsberg Ann,
Heyman Mats,
Kanerva Jukka,
HarilaSaari Arja,
Hasle Henrik,
Söderhäll Stefan,
Jónsson Ólafur Gisli,
Lydersen Stian,
Schmiegelow Kjeld
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22719
Subject(s) - medicine , hazard ratio , incidence (geometry) , confidence interval , hematopoietic stem cell transplantation , mortality rate , cause of death , transplantation , disease , physics , optics
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. Pediatr Blood Cancer 2011;56:551–559. © 2010 Wiley‐Liss, Inc.