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Causes of Death in Childhood Acute Lymphoblastic Leukemia at Hue Central Hospital for 10 Years (2008-2018)
Tran Kiem Hao1, Pham Nhu Hiep1, Nguyen Thi Kim Hoa1
1Pediatric Center, Hue Central Hospital, Vietnam.
Insights
Infection is the leading cause of death in childhood acute lymphoblastic leukemia (ALL). Improving supportive care, particularly infection prevention and control, is crucial for better patient outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Diseases
Background:
- Childhood acute lymphoblastic leukemia (ALL) remains a significant cause of pediatric cancer mortality.
- Understanding the primary causes of death is essential for improving treatment protocols and patient survival rates.
Purpose of the Study:
- To investigate the predominant causes of mortality among children diagnosed with acute lymphoblastic leukemia (ALL).
- To identify specific factors contributing to death in pediatric ALL patients treated at Hue Central Hospital.
Main Methods:
- A retrospective descriptive study was conducted on pediatric patients with ALL who died between 2008 and 2018.
- Data were collected from medical records of 238 ALL patients, focusing on the causes and circumstances of death.
Main Results:
- Infection was the leading cause of death in 43.2% of cases, with pneumonia being a common manifestation.
- Relapse accounted for 27.0% of deaths, frequently occurring in the bone marrow and often early in the disease course.
- Patients who died from infection often had an absolute neutrophil count below 500/µL, indicating severe immunosuppression.
Conclusions:
- Infection is the primary driver of mortality in childhood acute lymphoblastic leukemia (ALL) patients in this cohort.
- Enhanced supportive care, focusing on robust infection prevention and control strategies, is imperative to reduce ALL-related deaths.
- Addressing early relapse and improving management of neutropenia are also critical for improving survival rates.
Abstract:
Aim. To analyze the common cause of death in childhood acute lymphoblastic leukemia patients. Methods and Materials. A retrospective descriptive study on children with acute lymphoblastic leukemia who died at Hue Central Hospital between 2008 and 2018. All the patients were treated with the same protocol of modified Children's Cancer Group 1882 and 1881. Results. A total of 238 children with acute lymphoblastic leukemia who were cared for at our center were enrolled. Of these, there were 74 deaths. Among the death group, the male-to-female ratio was 2.7:1. Twenty-six (35.1%) occurred in maintenance phase, 18 (24.3%) occurred in induction phase, and 9 (12.2%) occurred in delayed intensification. Infection was responsible for deaths in 32 of 74 (43.2%) cases. Pseudomonas aeruginosa was found in 3 of 32 infected cases (9.4%) and resistance to almost all antibiotics in our hospital. Relapse, abandonment, and bleeding were documented in 20 (27.0%), 7 (9.5%), and 6 (8.1%) cases, respectively. Twenty-seven (84.3%) patients had absolute neutrophil count <500/µL. Of 32 infectious deaths, pneumonia occurred in 40.6%. Regarding 20 relapse death, bone marrow was the major site of relapse and it occurred in 13 (65%) cases. And there were 65% patients with very early relapse. Conclusions. Infection is the major cause of mortality in acute lymphoblastic leukemia patients in our study. To improve outcome, we should improve supportive care, especially prevention and control infection.
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