Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia

TY - JOUR

T1 - Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia

AU - Lund, Bendik

AU - Åsberg, Ann

AU - Heyman, Mats

AU - Kanerva, Jukka

AU - Harila-Saari, Arja

AU - Hasle, Henrik

AU - Söderhäll, Stefan

AU - Jónsson, Ólafur Gisli

AU - Lydersen, Stian

AU - Schmiegelow, Kjeld

AU - Nordic Society of Paediatric Haematology and Oncology

N1 - Copyright © 2010 Wiley-Liss, Inc.

PY - 2011/4/1

Y1 - 2011/4/1

N2 - 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 (≥200×109/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.

AB - 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 (≥200×109/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.

U2 - 10.1002/pbc.22719

DO - 10.1002/pbc.22719

M3 - Journal article

SN - 1545-5009

VL - 56

SP - 551

EP - 559

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

IS - 4

ER -