title: Induction death and treatment-related mortality in first remission of children with acute lymphoblastic leukemia: a population-based analysis of the Austrian Berlin-Frankfurt-Münster study group.
abstract: In the management of the childhood acute lymphoblastic leukemia (ALL), 5% of failures are due to induction death and treatment-related deaths in first complete remission. We retrospectively analyzed the incidence, pattern and causes of death and its risk factors for 896 children with ALL enrolled into five Austrian (A) Berlin-Frankfurt-Münster (BFM) trials between 1981 and 1999. The estimated 10-year cumulative incidence of death significantly decreased from 6+/-1% (n=16/268) in trials ALL-BFM-A 81 and ALL-A 84 to 2+/-1% (n=15/628) in trials ALL-BFM-A 86, 90 and 95 (P=0.006). A significant reduction of death was evident during induction therapy (2.2% in trials ALL-BFM-A 81 and ALL-A 84 and 0.2% in trials ALL-BFM-A 86, 90 and 95, P=0.001). Of 31 patients, 21 (68%) patients died from infectious and 10 (32%) from noninfectious complications. Treatment in trial ALL-BFM-A 81, infant age and female gender were independent predictors of an enhanced risk for death. Conclusively, we found a progressive reduction of death rates that may be explained by the increasing experience in specialized hemato-oncologic centers and improved supportive and intensive care. We also identified a distinct subset of patients who are especially prone to death and may need a special focus when receiving intense chemotherapy.
authors.affiliation: Department of Paediatric Haematology and Oncology, St Anna Children's Hospital, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Prucker
authors.forename: A
authors.initials: A
authors.lastname: Attarbaschi
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: M N
authors.initials: MN
authors.lastname: Dworzak
authors.forename: U
authors.initials: U
authors.lastname: Pötschger
authors.forename: C
authors.initials: C
authors.lastname: Urban
authors.forename: F-M
authors.initials: FM
authors.lastname: Fink
authors.forename: B
authors.initials: B
authors.lastname: Meister
authors.forename: K
authors.initials: K
authors.lastname: Schmitt
authors.forename: O A
authors.initials: OA
authors.lastname: Haas
authors.forename: H
authors.initials: H
authors.lastname: Gadner
authors.forename: G
authors.initials: G
authors.lastname: Mann
mesh_terms: D000970:Antineoplastic Agents / Q000633:toxicity*; D002423:Cause of Death; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000401:mortality*; D012074:Remission Induction
chemical_list: D000970:Antineoplastic Agents