Search: onr:"swepub:oai:DiVA.org:umu-146193" >
Treatment-related m...
Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia
-
- Oskarsson, Trausti (author)
- Karolinska Institutet
-
- Söderhäll, Stefan (author)
- Karolinska Institutet
-
- Arvidson, Johan, 1953- (author)
- Uppsala universitet,Barnneurologi/Barnonkologi
-
show more...
-
- Forestier, Erik (author)
- Umeå universitet,Medicinsk och klinisk genetik,Umea Univ, Dept Med Biosci, Umea, Sweden.
-
- Frandsen, Thomas L. (author)
- Rigshosp, Univ Hosp, Dept Pediat & Adolescent Med, Copenhagen, Denmark.
-
- Hellebostad, Marit (author)
- Drammen Hosp, Dept Pediat, Drammen, Norway.
-
- Lähteenmäki, Päivi (author)
- Turku Univ Hosp, Dept Pediat, Turku, Finland.;Turku Univ, Turku, Finland.
-
- Jónsson, Ólafur G. (author)
- Landspitali Univ Hosp, Childrens Hosp, Reykjavik, Iceland.
-
- Myrberg, Ida Hed (author)
- Karolinska Institutet
-
- Heyman, Mats (author)
- Karolinska Institutet
-
show less...
-
(creator_code:org_t)
- 2017-12-12
- 2018
- English.
-
In: Pediatric Blood & Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 65:4
- Related links:
-
https://onlinelibrar...
-
show more...
-
https://urn.kb.se/re...
-
https://doi.org/10.1...
-
https://urn.kb.se/re...
-
http://kipublication...
-
show less...
Abstract
Subject headings
Close
- 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.
Subject headings
- 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)
Keyword
- acute lymphoblastic leukemia
- hematopoietic stem cell transplantation
- infection
- pediatric
- relapse
- treatment-related mortality
Publication and Content Type
- ref (subject category)
- art (subject category)
Find in a library
To the university's database
- By the author/editor
-
Oskarsson, Traus ...
-
Söderhäll, Stefa ...
-
Arvidson, Johan, ...
-
Forestier, Erik
-
Frandsen, Thomas ...
-
Hellebostad, Mar ...
-
show more...
-
Lähteenmäki, Päi ...
-
Jónsson, Ólafur ...
-
Myrberg, Ida Hed
-
Heyman, Mats
-
show less...
- About the subject
-
- MEDICAL AND HEALTH SCIENCES
-
MEDICAL AND HEAL ...
-
and Clinical Medicin ...
-
and Hematology
-
- MEDICAL AND HEALTH SCIENCES
-
MEDICAL AND HEAL ...
-
and Clinical Medicin ...
-
and Pediatrics
-
- MEDICAL AND HEALTH SCIENCES
-
MEDICAL AND HEAL ...
-
and Clinical Medicin ...
-
and Cancer and Oncol ...
- Articles in the publication
-
Pediatric Blood ...
- By the university
-
Umeå University
-
Uppsala University
-
Karolinska Institutet