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Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Outcomes for paediatric acute leukaemia patients admitted to the paediatric intensive care unit
Marina Caballero1, Anna Faura1, Adriana Margarit1
1Department of Haematology/Oncology, Hospital Sant Joan de Déu, Barcelona, Spain.
Insights
Children with acute leukaemia (AL) admitted to the paediatric intensive care unit (PICU) have lower mortality than those with stem cell transplants. Sepsis was the primary reason for PICU admission, indicating increased severity and longer hospital stays.
Area of Science:
- Pediatric critical care medicine
- Pediatric oncology
- Hematology
Background:
- Acute leukaemia (AL) is the most common childhood cancer, with a significant proportion requiring paediatric intensive care unit (PICU) admission.
- Data on PICU outcomes for children with AL, particularly those without a history of stem cell transplant (HSCT) or CAR T-cell therapy, are limited.
Purpose of the Study:
- To investigate the clinical and epidemiological characteristics of children with AL admitted to the PICU.
- To analyze the outcomes of these high-risk pediatric patients.
Main Methods:
- A retrospective, single-centre observational study was conducted from January 2011 to December 2018.
- Included were pediatric patients (28 days to 18 years) with AL admitted to the PICU, excluding those with prior HSCT or CAR T-cell therapy.
- Data collected included demographics, clinical findings, laboratory results, microbiology, and patient outcomes.
Main Results:
- Forty-three AL patients experienced 63 PICU admissions. Major reasons included sepsis (33.3%), hyperleukocytosis (19%), respiratory failure (17.5%), and seizures (12.7%).
- Inotropic support was required by 30.2% and mechanical ventilation by 23.8%. In-hospital mortality was 6.9%, with 60-day and 1-year mortality rates of 9.3% and 13.9%, respectively.
- Mortality was lower than in patients with HSCT history but higher than in those with solid tumors. Sepsis was linked to greater severity and longer hospital stays.
Conclusions:
- Infection, primarily sepsis, is the leading cause for PICU admission in children with AL.
- Sepsis in this cohort is associated with increased disease severity and prolonged hospitalization.
- The overall mortality for pediatric AL patients in the PICU, excluding HSCT/CAR T-cell therapy, is relatively low but warrants careful management, especially for infectious complications.
Abstract:
Children with acute leukaemia (AL) are a high-risk population for infections and life-threatening conditions requiring paediatric intensive care unit (PICU) admission, presenting an increased mortality rate. A few literature exists about PICU outcomes in this kind of patients, especially with haematopoietic stem cell transplant (HSCT) background. We investigated the clinical and epidemiological characteristics of these patients as well as their outcomes. A retrospective, single-centre analytical/observational study was conducted from January 2011 to December 2018 in the PICU of a tertiary care hospital. AL patients from 28 days to 18 years old admitted to the PICU were included, excluding those with histories of HSCT or CAR T-cell therapy. We collected epidemiological and clinical characteristics, laboratory and microbiology results and outcomes. Forty-three patients with AL required urgent admission (35 lymphoblastic and 8 myeloblastic) for 63 different episodes. The main reasons were sepsis (21, 33.3%), hyperleukocytosis (12, 19%), respiratory failure (11, 17.5%) and seizures (8, 12.7%). Nineteen (30.2%) required inotropic support, and fifteen (23.8%) required mechanical ventilation. Three patients died at the hospital (3/43, 6.9%). Sixty-day mortality was 9.3%, and 1-year mortality was 13.9%. There was no differences regarding the type of AL and 60-day mortality (log-rank 2.652, p = 0.103).Conclusion: In our study, the main cause of admission for AL patients was infection, which was associated to more severity and longer hospital admission. What is Known: • Acute leukaemia is the most common childhood cancer. Admission to a paediatric intensive care unit is required in 30% of children with acute leukaemia. • Regarding the outcomes of children with acute leukaemia that require admission to the intensive care unit data are scarce. What is New: • Mortality in acute leukaemia patients admitted to the paediatric intensive care unit is lower than that of patients with a history of stem cell therapy but higher than that of patients with solid tumours. • The main reason for admission was sepsis, which is related in literature to more severity and long length of stay.
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