TY - JOUR
T1 - Causes of death - Other than progressive leukemia - In childhood acute lymphoblastic (ALL) and myeloid leukemia (AML)
T2 - The Dutch Childhoold Oncology Group experience
AU - Slats, A. M.
AU - Egeler, R. M.
AU - van der Does-van den Berg, A.
AU - Korbijn, C.
AU - Hählen, K.
AU - Kamps, W. A.
AU - Veerman, A. J.P.
AU - Zwaan, C. M.
PY - 2005/4
Y1 - 2005/4
N2 - We analyzed causes of death, other than resistant disease or relapse, in 875 children with acute lymphoblastic leukemia (ALL) and 229 with acute myeloid leukemia (AML), treated on three different Dutch Childhood Oncology Group (DCOG) ALL and three AML protocols. Overall, 23 (2.6%) ALL and 44 (19.2%) AML patients died. Early death (ED, before remission was reached) occurred in nine ALL (1%) and thirty AML (13.1%) patients, including three and ten deaths before treatment was initiated. Chemotherapy-related mortality in remission (CRM) occurred in nine ALL (1.1%) and eight AML (4.4%) patients. For ALL, both ED and CRM declined over time, although this was not statistically significant. For AML a decrease in ED was observed (from 26% to approximately 10%), but counter-balanced by an increase in CRM (from 3 to 8%), maybe related to the scheduling of intensification blocks in AML-92/94. Including transplant-related mortality, death in CR rates in AML increased from 3 to 15% in the last study. The main cause of ED was hemorrhage, often associated with hyperleucocytosis, and infection for CRM. We conclude that mortality dropped favorably in ALL, but not in AML. Especially for AML, effective but less toxic therapy and better supportive care guidelines need to be developed.
AB - We analyzed causes of death, other than resistant disease or relapse, in 875 children with acute lymphoblastic leukemia (ALL) and 229 with acute myeloid leukemia (AML), treated on three different Dutch Childhood Oncology Group (DCOG) ALL and three AML protocols. Overall, 23 (2.6%) ALL and 44 (19.2%) AML patients died. Early death (ED, before remission was reached) occurred in nine ALL (1%) and thirty AML (13.1%) patients, including three and ten deaths before treatment was initiated. Chemotherapy-related mortality in remission (CRM) occurred in nine ALL (1.1%) and eight AML (4.4%) patients. For ALL, both ED and CRM declined over time, although this was not statistically significant. For AML a decrease in ED was observed (from 26% to approximately 10%), but counter-balanced by an increase in CRM (from 3 to 8%), maybe related to the scheduling of intensification blocks in AML-92/94. Including transplant-related mortality, death in CR rates in AML increased from 3 to 15% in the last study. The main cause of ED was hemorrhage, often associated with hyperleucocytosis, and infection for CRM. We conclude that mortality dropped favorably in ALL, but not in AML. Especially for AML, effective but less toxic therapy and better supportive care guidelines need to be developed.
KW - ALL
KW - AML
KW - Toxicity
KW - Treatment-related mortality
UR - http://www.scopus.com/inward/record.url?scp=17144362870&partnerID=8YFLogxK
U2 - 10.1038/sj.leu.2403665
DO - 10.1038/sj.leu.2403665
M3 - Article
C2 - 15690069
AN - SCOPUS:17144362870
SN - 0887-6924
VL - 19
SP - 537
EP - 544
JO - Leukemia
JF - Leukemia
IS - 4
ER -