title: Long term survival in children with acute leukaemia and complications requiring mechanical ventilation.
abstract: OBJECTIVE
  Previous reports have indicated that the short term prognosis for patients with malignant diseases and serious adverse events requiring mechanical ventilation (SAEV) is improving. The purpose of this study was to determine whether these patients can be cured of malignant disease or whether they survive SAEV only to subsequently relapse.
  
  
  METHODS
  The authors report the outcome of children with SAEV treated in the multicentre studies ALL-BFM 95 and AML-BFM 98. Data from 1182 patients with acute lymphoblastic leukaemia (ALL) and 334 patients with acute myeloid leukaemia (AML) were analysed. 88 patients (51 ALL and 37 AML) developed SAEV.
  
  
  RESULTS
  The prognosis was almost identical in ALL and AML patients (survival of SAEV patients: 48%, 95% CI 38% to 58%; overall survival after 5 years: 31%, 95% CI 21% to 41%). Prognosis was independent of the time between leukaemia diagnosis and SAEV. Approximately 20% of children who required haemodialysis (n=14) or cardiac resuscitation (n=16) achieved long term survival, but no patient who fulfilled more than three of six identified risk factors (age ≥10 years, high risk leukaemia, C reactive protein ≥150 mg/l, administration of inotropic infusion, cardiac resuscitation and haemodialysis) survived (n=16; 0%, 95% CI 0% to 20%).
  
  
  CONCLUSIONS
  Intensive care improves the short and long term survival of children with leukaemia. 64% (95% CI 50% to 78%) of children with acute leukaemia who survived SAEV achieved long term survival. Prognosis mainly depends on age and leukaemia risk group.
authors: Children's Hospital, University Children's Hospital Ulm, Eythstrasse 24, 89075 Ulm, Germany. daniel@Steinba.ch
authors: Daniel
authors: D
authors: Steinbach
authors: Bernhard
authors: B
authors: Wilhelm
authors: Hans-Rudolf
authors: HR
authors: Kiermaier
authors: Ursula
authors: U
authors: Creutzig
authors: Martin
authors: M
authors: Schrappe
authors: Martin
authors: M
authors: Zimmermann
authors: Klaus-Michael
authors: KM
authors: Debatin
authors: Bernd
authors: B
authors: Gruhn
authors: Arend
authors: A
authors: von Stackelberg
authors: Heribert
authors: H
authors: Jürgens
authors: Brigitte
authors: B
authors: Strahm
authors: Dirk
authors: D
authors: Reinhardt
authors: Anja
authors: A
authors: Möricke
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012151:Resuscitation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D002097:C-Reactive Protein