Treatment-related mortality in children with acute lymphoblastic leukaemia in a low-middle income country
1, Mahwish Faizan1, Wasila Shamim1
1Department of Pediatric Hematology/Oncology and BMT, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Insights
Treatment-related mortality is a major cause of death in children with acute lymphoblastic leukaemia (ALL). Sepsis is the most frequent cause, highlighting the need for improved preventative strategies in paediatric ALL care.
Area of Science:
- Paediatric Haematology-Oncology
- Clinical Research
- Epidemiology
Background:
- Acute lymphoblastic leukaemia (ALL) is a significant cause of mortality in children.
- Treatment-related mortality (TRM) is a critical concern in paediatric oncology.
- Understanding TRM in ALL is essential for improving patient outcomes.
Purpose of the Study:
- To determine the proportion of treatment-related mortality (TRM) among all mortalities in paediatric acute lymphoblastic leukaemia (ALL) patients.
- To identify the primary causes of TRM in this population.
- To identify risk factors associated with TRM in paediatric ALL.
Main Methods:
- An observational retrospective study was conducted using data from January 2017 to September 2018.
- Data included paediatric patients with ALL who expired during treatment; deaths due to relapse or before treatment were excluded.
- Statistical analysis was performed using SPSS 16.
Main Results:
- Out of 247 deaths, 144 (58.3%) were classified as treatment-related mortality.
- Sepsis was the most common cause (87.5%), followed by haemorrhagic complications (7.6%).
- Factors associated with TRM included weight-for-age, immunophenotype, reason for admission, and absolute neutrophil count (p<0.05).
Conclusions:
- Treatment-related mortality is a significant and potentially avoidable cause of death in paediatric ALL.
- Sepsis is the predominant cause of TRM in paediatric ALL patients.
- Identifying risk factors is crucial for developing targeted interventions to reduce TRM.
Objective:
To determine the proportion of treatment-related mortality among mortalities of paediatric acute lymphoblastic leukaemia and to identify probable causes and risk factors.
Methods:
The observational retrospective study was conducted in February-March 2019 at the Department of Paediatric Haematology-Oncology and Bone Marrow Transplant, the Children's Hospital and the Institute of Child Health, Lahore, Pakistan, and comprised data of all paediatric patients of acute lymphoblastic leukaemia who expired during treatment from January 2017 till September 2018. Death due to relapse and deaths before treatment were excluded. Data was analysed using SPSS 16.
Results:
Of the 247 deaths during the study period, 144(58.3%) were treatment-related mortality cases; 81(56.2%) males and 63(43.8%) females with an overall mean age of 5.0±3.83 years. The commonest cause was sepsis 126(87.5%), followed by haemorrhagic complications 11(7.6%), drug toxicity 4(2.8%), tumour lysis syndrome 2(1.4%) and thromboembolism 1(0.7%). Significant factors associated with treatment-related mortality were weight-for-age, immunophenotype, the reason for admission, and absolute neutrophil count (p<0.05).
Conclusions:
Treatment-related mortality, though potentially avoidable, was found to be a major cause of death among paediatric patients of acute lymphoblastic leukaemia, and sepsis was the most common cause.
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