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Remission death in acute lymphoblastic leukaemia: a changing pattern
A Atra1, S M Richards, J M Chessells
1Department of Haematology and Oncology, Hospitals for Sick Children, London.
Archives of Disease in Childhood
|November 1, 1993
Summary
Childhood acute lymphoblastic leukemia (ALL) treatment has improved, but death during remission remains a concern. Intensive therapy reduced induction deaths, yet remission mortality persists, influenced by factors like age and Down's syndrome.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a significant childhood cancer.
- Remission deaths represent a critical challenge in ALL management.
- Understanding trends in remission mortality is crucial for improving outcomes.
Purpose of the Study:
- To analyze the pattern and risk factors of death in remission among children with ALL.
- To evaluate changes in remission death causes over an 18-year period.
- To identify strategies for reducing mortality in ALL survivors.
Main Methods:
- Retrospective analysis of 842 children with ALL treated over 18 years.
- Examination of mortality rates during different treatment phases and time periods.
- Identification of factors associated with increased risk of remission death.
Main Results:
- Overall leukemia mortality decreased significantly with intensified treatment.
- Remission induction mortality dropped from 3.5% to under 1%.
- Remission death rate remained constant (5-6%), with increased deaths from gut toxicity and intensified treatment periods; decreased infectious deaths (measles, herpes).
- Younger age, higher leucocyte count, bone marrow transplantation, and Down's syndrome were risk factors for remission death.
- Four cases of second neoplasms were observed.
Conclusions:
- While ALL treatment has advanced, significant risks of death in remission persist.
- The pattern of infectious deaths has shifted, with increased non-infectious causes.
- Improved supportive care, vigilant monitoring post-intensification, and optimized antimicrobial/cytokine therapy are essential to reduce avoidable remission deaths.