title: Effect of age and body weight on toxicity and survival in pediatric acute myeloid leukemia: results from NOPHO-AML 2004.
abstract: Treatment for pediatric acute myeloid leukemia is very toxic and the association between outcome and age and Body Mass Index is unclear. We investigated effect of age and Body Mass Index on toxicity and survival in pediatric acute myeloid leukemia. We studied all patients who completed first induction course of NOPHO-AML 2004 (n=318). Toxicity following induction and consolidation courses (n=6) was analyzed. The probabilities of toxicity and death were determined using time-to-event analyses with Cox multivariate proportional hazard regression for comparative analyses. Age 10-17 years was associated with sepsis with hypotension [hazard ratio 2.3 (95% confidence interval 1.1-4.6)]. Being overweight (>1 standard deviation) was associated with requiring supplemental oxygen [1.9 (1.0-3.5)]. The 5-year event-free and overall survival were 47% and 71%. Children aged 10-17 years showed a trend for inferior 5-year overall survival compared to children aged 2-9 (64% vs. 76%; P=0.07). Infants showed a trend for superior 5-year event-free survival (66% vs. 43%; P=0.06). Overweight children aged 10-17 years showed a trend for superior survival [5-year event-free survival 59% vs. 40% (P=0.09) and 5-year overall survival 78% vs. 56% (P=0.06)] compared to healthy weight children aged 10-17 years. In conclusion, children aged 10-17 years and overweight children had a higher risk of grade 3-4 toxicity. Children aged 10-17 years showed inferior survival, but, unexpectedly, in this age group overweight children tended to have increased survival. This suggests different pharmacokinetics of chemotherapeutic drugs in adolescents and warrants further studies.
authors.affiliation: Department of Pediatrics, Aarhus University Hospital Skejby, Denmark dadolfsen@gmail.com.
authors.forename: Ditte J A
authors.initials: DJ
authors.lastname: Løhmann
authors.affiliation: Institution for Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Abrahamsson
authors.affiliation: Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology & Oncology Study Group (HKPHOSG), Hong Kong, China.
authors.forename: Shau-Yin
authors.initials: SY
authors.lastname: Ha
authors.affiliation: Department of Pediatrics, Landspitalinn, Reykjavik, Iceland.
authors.forename: Ólafur G
authors.initials: ÓG
authors.lastname: Jónsson
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospital, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Koskenvuo
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Lausen
authors.affiliation: Department of Woman's and Children's Health, Uppsala University, Sweden.
authors.forename: Josefine
authors.initials: J
authors.lastname: Palle
authors.affiliation: Department of Pediatric Medicine, Oslo University Hospital, Norway.
authors.forename: Bernward
authors.initials: B
authors.lastname: Zeller
authors.affiliation: Department of Pediatrics, Aarhus University Hospital Skejby, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use / Q000633:toxicity*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D060830:Consolidation Chemotherapy / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents