Treatment-related mortality in children with acute myeloid leukaemia in Central America: Incidence, timing and predictors

Sumit Gupta, Miguel Bonilla, Patricia Valverde, Ligia Fu, Scott Howard, Raul C. Ribeiro, Lillian Sung

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Cure rates in paediatric acute myeloid leukaemia in low-income countries lag behind those in high-income countries, in part secondary to higher rates of treatment-related mortality. Patterns of treatment-related mortality are likely to differ between low and high-income centres. Understanding low-income setting patterns is necessary before effective interventions aimed at decreasing treatment-related mortality can be designed. Our aim was to describe the incidence, timing and predictors of treatment-related mortality among Central American children with acute myeloid leukaemia. Patients and methods: We evaluated patients younger than 21 years diagnosed with acute myeloid leukaemia from 2000 to 2008 in El Salvador, Honduras or Guatemala. Biologic, socioeconomic and nutritional variables collected prospectively were examined as potential predictors of treatment-related mortality. Results: Among 279 patients, treatment-related mortality occurred in 65 (23%). Of 65 deaths, 51 (78.5%) occurred before or during induction, resulting in an early death rate of 18.3%. The most common causes of treatment-related mortality were infection (29/65; 45%) and haemorrhage (13/65; 20%). Infection accounted for 33% of treatment-related mortality before remission induction therapy versus 40% during induction and 77% after induction (P = 0.03). Rates of treatment-related mortality did not vary between time periods 1 and 2 (24.8% versus 21.4%; P = 0.32). Only lower initial platelet count predicted early death (odds ratio per 10 × 10 9/L = 0.88, 95% Confidence Interval (CI) 0.79-0.97; P < 0.001). Conclusions: Treatment-related mortality remains a significant cause of treatment failure. Supportive care interventions are needed. Children presenting with low initial platelet counts were at highest risk of induction death, suggesting that transfusion practices should be evaluated.

Original languageEnglish (US)
Pages (from-to)1363-1369
Number of pages7
JournalEuropean Journal of Cancer
Volume48
Issue number9
DOIs
StatePublished - Jun 1 2012

Fingerprint

Central America
Child Mortality
Acute Myeloid Leukemia
Mortality
Incidence
Therapeutics
Platelet Count
El Salvador
Honduras
Guatemala
Remission Induction
Infection
Treatment Failure
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Treatment-related mortality in children with acute myeloid leukaemia in Central America : Incidence, timing and predictors. / Gupta, Sumit; Bonilla, Miguel; Valverde, Patricia; Fu, Ligia; Howard, Scott; Ribeiro, Raul C.; Sung, Lillian.

In: European Journal of Cancer, Vol. 48, No. 9, 01.06.2012, p. 1363-1369.

Research output: Contribution to journalArticle

Gupta, Sumit ; Bonilla, Miguel ; Valverde, Patricia ; Fu, Ligia ; Howard, Scott ; Ribeiro, Raul C. ; Sung, Lillian. / Treatment-related mortality in children with acute myeloid leukaemia in Central America : Incidence, timing and predictors. In: European Journal of Cancer. 2012 ; Vol. 48, No. 9. pp. 1363-1369.
@article{d30f2775da534956bfd523e2d46c80ce,
title = "Treatment-related mortality in children with acute myeloid leukaemia in Central America: Incidence, timing and predictors",
abstract = "Background: Cure rates in paediatric acute myeloid leukaemia in low-income countries lag behind those in high-income countries, in part secondary to higher rates of treatment-related mortality. Patterns of treatment-related mortality are likely to differ between low and high-income centres. Understanding low-income setting patterns is necessary before effective interventions aimed at decreasing treatment-related mortality can be designed. Our aim was to describe the incidence, timing and predictors of treatment-related mortality among Central American children with acute myeloid leukaemia. Patients and methods: We evaluated patients younger than 21 years diagnosed with acute myeloid leukaemia from 2000 to 2008 in El Salvador, Honduras or Guatemala. Biologic, socioeconomic and nutritional variables collected prospectively were examined as potential predictors of treatment-related mortality. Results: Among 279 patients, treatment-related mortality occurred in 65 (23{\%}). Of 65 deaths, 51 (78.5{\%}) occurred before or during induction, resulting in an early death rate of 18.3{\%}. The most common causes of treatment-related mortality were infection (29/65; 45{\%}) and haemorrhage (13/65; 20{\%}). Infection accounted for 33{\%} of treatment-related mortality before remission induction therapy versus 40{\%} during induction and 77{\%} after induction (P = 0.03). Rates of treatment-related mortality did not vary between time periods 1 and 2 (24.8{\%} versus 21.4{\%}; P = 0.32). Only lower initial platelet count predicted early death (odds ratio per 10 × 10 9/L = 0.88, 95{\%} Confidence Interval (CI) 0.79-0.97; P < 0.001). Conclusions: Treatment-related mortality remains a significant cause of treatment failure. Supportive care interventions are needed. Children presenting with low initial platelet counts were at highest risk of induction death, suggesting that transfusion practices should be evaluated.",
author = "Sumit Gupta and Miguel Bonilla and Patricia Valverde and Ligia Fu and Scott Howard and Ribeiro, {Raul C.} and Lillian Sung",
year = "2012",
month = "6",
day = "1",
doi = "10.1016/j.ejca.2011.10.009",
language = "English (US)",
volume = "48",
pages = "1363--1369",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Limited",
number = "9",

}

TY - JOUR

T1 - Treatment-related mortality in children with acute myeloid leukaemia in Central America

T2 - Incidence, timing and predictors

AU - Gupta, Sumit

AU - Bonilla, Miguel

AU - Valverde, Patricia

AU - Fu, Ligia

AU - Howard, Scott

AU - Ribeiro, Raul C.

AU - Sung, Lillian

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Background: Cure rates in paediatric acute myeloid leukaemia in low-income countries lag behind those in high-income countries, in part secondary to higher rates of treatment-related mortality. Patterns of treatment-related mortality are likely to differ between low and high-income centres. Understanding low-income setting patterns is necessary before effective interventions aimed at decreasing treatment-related mortality can be designed. Our aim was to describe the incidence, timing and predictors of treatment-related mortality among Central American children with acute myeloid leukaemia. Patients and methods: We evaluated patients younger than 21 years diagnosed with acute myeloid leukaemia from 2000 to 2008 in El Salvador, Honduras or Guatemala. Biologic, socioeconomic and nutritional variables collected prospectively were examined as potential predictors of treatment-related mortality. Results: Among 279 patients, treatment-related mortality occurred in 65 (23%). Of 65 deaths, 51 (78.5%) occurred before or during induction, resulting in an early death rate of 18.3%. The most common causes of treatment-related mortality were infection (29/65; 45%) and haemorrhage (13/65; 20%). Infection accounted for 33% of treatment-related mortality before remission induction therapy versus 40% during induction and 77% after induction (P = 0.03). Rates of treatment-related mortality did not vary between time periods 1 and 2 (24.8% versus 21.4%; P = 0.32). Only lower initial platelet count predicted early death (odds ratio per 10 × 10 9/L = 0.88, 95% Confidence Interval (CI) 0.79-0.97; P < 0.001). Conclusions: Treatment-related mortality remains a significant cause of treatment failure. Supportive care interventions are needed. Children presenting with low initial platelet counts were at highest risk of induction death, suggesting that transfusion practices should be evaluated.

AB - Background: Cure rates in paediatric acute myeloid leukaemia in low-income countries lag behind those in high-income countries, in part secondary to higher rates of treatment-related mortality. Patterns of treatment-related mortality are likely to differ between low and high-income centres. Understanding low-income setting patterns is necessary before effective interventions aimed at decreasing treatment-related mortality can be designed. Our aim was to describe the incidence, timing and predictors of treatment-related mortality among Central American children with acute myeloid leukaemia. Patients and methods: We evaluated patients younger than 21 years diagnosed with acute myeloid leukaemia from 2000 to 2008 in El Salvador, Honduras or Guatemala. Biologic, socioeconomic and nutritional variables collected prospectively were examined as potential predictors of treatment-related mortality. Results: Among 279 patients, treatment-related mortality occurred in 65 (23%). Of 65 deaths, 51 (78.5%) occurred before or during induction, resulting in an early death rate of 18.3%. The most common causes of treatment-related mortality were infection (29/65; 45%) and haemorrhage (13/65; 20%). Infection accounted for 33% of treatment-related mortality before remission induction therapy versus 40% during induction and 77% after induction (P = 0.03). Rates of treatment-related mortality did not vary between time periods 1 and 2 (24.8% versus 21.4%; P = 0.32). Only lower initial platelet count predicted early death (odds ratio per 10 × 10 9/L = 0.88, 95% Confidence Interval (CI) 0.79-0.97; P < 0.001). Conclusions: Treatment-related mortality remains a significant cause of treatment failure. Supportive care interventions are needed. Children presenting with low initial platelet counts were at highest risk of induction death, suggesting that transfusion practices should be evaluated.

UR - http://www.scopus.com/inward/record.url?scp=84861331774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861331774&partnerID=8YFLogxK

U2 - 10.1016/j.ejca.2011.10.009

DO - 10.1016/j.ejca.2011.10.009

M3 - Article

C2 - 22082459

AN - SCOPUS:84861331774

VL - 48

SP - 1363

EP - 1369

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

IS - 9

ER -