title: Death during induction therapy and first remission of acute leukemia in childhood: the St. Jude experience.
abstract: 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.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. jeffrey.rubnitz@stjude.org
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Yinmei
authors.initials: Y
authors.lastname: Zhou
authors.forename: John T
authors.initials: JT
authors.lastname: Sandlund
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Razzouk
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents