title: Hyperglycemia during induction therapy is associated with poorer survival in children with acute lymphocytic leukemia.
abstract: 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.
authors.affiliation: Department of Pediatrics, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA. rys1@bcm.tmc.edu
authors.forename: Rona Y
authors.initials: RY
authors.lastname: Sonabend
authors.forename: Siripoom V
authors.initials: SV
authors.lastname: McKay
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Okcu
authors.forename: Jinrong
authors.initials: J
authors.lastname: Yan
authors.forename: Morey W
authors.initials: MW
authors.lastname: Haymond
authors.forename: Judith F
authors.initials: JF
authors.lastname: Margolin
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D001786:Blood Glucose; D005938:Glucocorticoids; D014750:Vincristine; D003907:Dexamethasone; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin