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Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia.
MedLine Citation:
PMID:  21298739     Owner:  NLM     Status:  Publisher    
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.
Bendik Lund; Ann Asberg; Mats Heyman; Jukka Kanerva; Arja Harila-Saari; Henrik Hasle; Stefan Söderhäll; Olafur Gisli Jónsson; Stian Lydersen; Kjeld Schmiegelow;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-8
Journal Detail:
Title:  Pediatric blood & cancer     Volume:  56     ISSN:  1545-5017     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-2-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101186624     Medline TA:  Pediatr Blood Cancer     Country:  -    
Other Details:
Languages:  ENG     Pagination:  551-559     Citation Subset:  -    
Copyright Information:
Copyright © 2010 Wiley-Liss, Inc.
Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Pediatrics, The University Hospital Rigshospitalet, Copenhagen, Denmark.
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