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Induction mortality, ATRA administration, and resource utilization in a nationally representative cohort of children with acute promyelocytic leukemia in the United States from 1999 to 2009
Author(s) -
Fisher Brian T.,
Singh Sonia,
Huang YuanShung,
Li Yimei,
Gregory John,
Walker Dana,
Seif Alix E.,
Kavcic Marko,
Aplenc Richard
Publication year - 2014
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.24585
Subject(s) - acute promyelocytic leukemia , medicine , cohort , retinoic acid , leukemia , acute leukemia , tretinoin , induction therapy , retrospective cohort study , pediatrics , promyelocytic leukemia protein , chemotherapy , biochemistry , chemistry , gene
Background Limited data exist on induction mortality of pediatric patients with acute promyelocytic leukemia in the United States, usage of all‐trans retinoic acid (ATRA) during acute promyelocytic leukemia induction, and the resources needed to deliver induction therapy. Procedure Using the Pediatric Health Information System database we established a retrospective cohort of patients treated for newly diagnosed acute promyelocytic leukemia with ATRA between January 1999 and September 2009 in 32 of 43 PHIS contributing free‐standing pediatric hospitals in the United States. Standard statistical methods were used to determine in‐hospital induction mortality, ATRA administration, and resource utilization during a 60‐day observation period. Results A total of 163 children were identified who met eligibility criteria for cohort inclusion; 52% were female and 76% were white with an average age of 12.7 years. A total of 12 patients (7.4%) died, with 7 (58.3%) dying within the first 7 days of first admission. The mean time to first ATRA exposure increased with decreasing age ( P = 0.0016). Resource utilization for management of retinoic acid syndrome was higher than anticipated based on prior studies and differed significantly from patients with non‐M3 acute myeloid leukemia. Conclusions The induction mortality for pediatric acute promyelocytic leukemia remains substantial with wide variation in ATRA administration and high rates of resource utilization. Pediatr Blood Cancer 2014;61:68–73. © 2013 Wiley Periodicals, Inc.