Hyperglycemia during induction therapy is associated with poorer survival in children with acute lymphocytic leukemia.
OBJECTIVE
To investigate whether children with acute lymphocytic leukemia (ALL) who have development of hyperglycemia during induction may have worse relapse-free (RFS) and overall survival (OS) rates.


METHODS
A review of 167 children diagnosed with ALL between 1999 to 2002 at Texas Children's Hospital was performed. Blood glucose concentrations during induction therapy were reviewed; patients were assigned to 3 groups: euglycemia (blood glucose < 140 mg/dL), mild hyperglycemia (blood glucose between 140-200 mg/dL), and overt hyperglycemia (blood glucose > 200 mg/dL). RFS and OS among groups were compared by use of Kaplan-Meier and Cox-proportional hazard analyses, adjusting for potential confounding variables.


RESULTS
The median follow-up in survivors was 6 years; there were 18 deaths and 36 relapses. Overt hyperglycemia was seen in 56 (34%) patients. Patients with overt hyperglycemia had poorer RFS (68% +/- [SE] 6.7 vs 85% +/- 3.6, P = .025) and OS (74% +/- 6.1 vs 96% +/- 1.9, P < .0001) at 5 years than their counterparts. Patients with overt hyperglycemia had 6.2 times (95% CI 1.6-24.7, P = .01) greater risk for death, independent of risk group and type of steroid.


CONCLUSIONS
Overt hyperglycemia may be an independent predictor of survival in children with ALL.
Sonabend
Rona Y
RY
Department of Pediatrics, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA. rys1@bcm.tmc.edu
McKay
Siripoom V
SV
Okcu
M Fatih
MF
Yan
Jinrong
J
Haymond
Morey W
MW
Margolin
Judith F
JF
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001215:Asparaginase / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003630:Daunorubicin / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004926:Escherichia coli / Q000201:enzymology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality*; D011241:Prednisone / Q000627:therapeutic use; D012720:Severity of Illness Index; D014750:Vincristine / Q000627:therapeutic use
D000970:Antineoplastic Agents; D001786:Blood Glucose; D005938:Glucocorticoids; D014750:Vincristine; D003907:Dexamethasone; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin