Death during induction therapy and first remission of acute leukemia in childhood: the St. Jude experience.
BACKGROUND
Despite improvements in supportive care, death due to treatment toxicity remains a significant problem for children treated for acute leukemia.


METHODS
To determine the causes of and risk factors for death unrelated to refractory leukemia, to disease recurrence, or to second malignancy, the authors reviewed the records of 1011 patients with acute lymphoblastic leukemia (ALL) and 260 patients with acute myeloid leukemia (AML) treated between 1984 and 1999 and between 1983 and 2002, respectively, at St. Jude Children's Research Hospital (Memphis, TN). Data for patients who underwent stem cell transplantation were censored at the time of transplantation.


RESULTS
For patients with ALL, the estimated 10-year cumulative incidence of death was 2.9% +/- 5.3%. Age was the only predictor of death. Patients with ALL 1-9 years old had a significantly lower risk of death than did younger or older patients (P = 0.002). For patients with AML, the estimated 5-year cumulative incidence of death was 7.6% +/- 1.9%. Increasing age and increasing leukocyte count were significantly associated with increased risk of death. For patients with ALL and with AML, the incidence of death remained relatively constant during the time periods studied. Infection was the most common cause of death.


CONCLUSIONS
In the current study, the authors determined that children > or = 10 years of age are at increased risk of death during therapy for ALL and AML.
Rubnitz
Jeffrey E
JE
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. jeffrey.rubnitz@stjude.org
Lensing
Shelly
S
Zhou
Yinmei
Y
Sandlund
John T
JT
Razzouk
Bassem I
BI
Ribeiro
Raul C
RC
Pui
Ching-Hon
CH
D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D007958:Leukocyte Count; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects
D000970:Antineoplastic Agents