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Treatment-related m...
Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia
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- Oskarsson, Trausti (författare)
- Karolinska Institutet
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- Söderhäll, Stefan (författare)
- Karolinska Institutet
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- Arvidson, Johan, 1953- (författare)
- Uppsala universitet,Barnneurologi/Barnonkologi
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- Forestier, Erik (författare)
- Umeå universitet,Medicinsk och klinisk genetik,Umea Univ, Dept Med Biosci, Umea, Sweden.
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- Frandsen, Thomas L. (författare)
- Rigshosp, Univ Hosp, Dept Pediat & Adolescent Med, Copenhagen, Denmark.
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- Hellebostad, Marit (författare)
- Drammen Hosp, Dept Pediat, Drammen, Norway.
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- Lähteenmäki, Päivi (författare)
- Turku Univ Hosp, Dept Pediat, Turku, Finland.;Turku Univ, Turku, Finland.
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- Jónsson, Ólafur G. (författare)
- Landspitali Univ Hosp, Childrens Hosp, Reykjavik, Iceland.
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- Myrberg, Ida Hed (författare)
- Karolinska Institutet
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- Heyman, Mats (författare)
- Karolinska Institutet
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(creator_code:org_t)
- 2017-12-12
- 2018
- Engelska.
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Ingår i: Pediatric Blood & Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 65:4
- Relaterad länk:
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https://onlinelibrar...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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http://kipublication...
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Abstract
Ämnesord
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- Background: Treatment of relapsed childhood acute lymphoblastic leukemia (ALL) is particularly challenging due to the high treatment intensity needed to induce and sustain a second remission. To improve results, it is important to understand how treatment-related toxicity impacts survival.Procedure: In this retrospective population-based study, we described the causes of death and estimated the risk for treatment-related mortality in patients with first relapse of childhood ALL in the Nordic Society of Paediatric Haematology and Oncology ALL-92 and ALL-2000 trials.Results: Among the 483 patients who received relapse treatment with curative intent, we identified 52 patients (10.8%) who died of treatment-related causes. Twelve of these died before achieving second remission and 40 died in second remission. Infections were the cause of death in 38 patients (73.1%), predominantly bacterial infections during the chemotherapy phases of the relapse treatment. Viral infections were more common following hematopoietic stem cell transplantation (HSCT) in second remission. Independent risk factors for treatment-related mortality were as follows: high-risk stratification at relapse (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.3-3.9; P < 0.01), unfavorable cytogenetic aberrations (HR 3.4; 95% CI 1.3-9.2; P = 0.01), and HSCT (HR 4.64; 95% CI 2.17-9.92; P < 0.001). In contrast to previous findings, we did not observe any statistically significant sex or age differences. Interestingly, none of the 17 patients with Down syndrome died of treatment-related causes.Conclusions: Fatal treatment complications contribute significantly to the poor overall survival after relapse. Implementation of novel therapies with reduced toxicity and aggressive supportive care management are important to improve survival in relapsed childhood ALL.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Hematologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Hematology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Pediatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Pediatrics (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Nyckelord
- acute lymphoblastic leukemia
- hematopoietic stem cell transplantation
- infection
- pediatric
- relapse
- treatment-related mortality
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- ref (ämneskategori)
- art (ämneskategori)
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Oskarsson, Traus ...
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Söderhäll, Stefa ...
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Arvidson, Johan, ...
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Forestier, Erik
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Frandsen, Thomas ...
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Hellebostad, Mar ...
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Lähteenmäki, Päi ...
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Jónsson, Ólafur ...
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Myrberg, Ida Hed
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Heyman, Mats
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Pediatric Blood ...
- Av lärosätet
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Umeå universitet
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Uppsala universitet
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Karolinska Institutet