Causes of early death and treatment‐related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group

• Published in: Pediatric blood & cancer Vol. 67; no. 4; pp. e28099 - n/a
• Main Authors: Klein, Kim, Litsenburg, Raphaële R.L., Haas, Valérie, Dors, Natasja, den Heuvel‐Eibrink, Marry M., Knops, Rutger R.G., Tissing, Wim J.E., Versluys, Birgitta A., Zwaan, C. Michel, Kaspers, Gertjan J.L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2020
• Subjects: Acute myeloid leukemia; Childhood; Children; Death; death in CR1; Hematology; Leukemia; Myeloid leukemia; Oncology; outcome; Patients; pediatric acute myeloid leukemia/pediatric AML; Pediatrics; Remission; Risk factors; Toxicity; treatment‐related mortality; Underweight; toxicity; death in CR1; pediatric acute myeloid leukemia/pediatric AML; outcome; treatment-related mortality
• ISSN: 1545-5009; 1545-5017; 1545-5017
• DOI: 10.1002/pbc.28099

Background With the current more effective treatment regimens for pediatric acute myeloid leukemia (AML), research on early death (ED), treatment‐related mortality (TRM), and toxicity becomes increasingly important. The aim of this study was to give an overview of the frequency, clinical features, and risk factors associated with ED and TRM in first complete remission (CR1) during the last three consecutive treatment protocols of the Dutch Childhood Oncology Group (DCOG) between 1998 and 2014. Methods Incidence and risk factors associated with ED and TRM in CR1 were retrospectively studied in 245 patients treated according to the Dutch ANLL‐97/AML‐12 (n = 118), AML‐15 (n = 60), or DB AML‐01 (n = 67) protocols. Results The incidence of ED was, respectively, 5.1%, 6.7%, and 3.0% excluding deaths before treatment (P = NS), and 7.4%, 11.1%, and 4.4% including deaths before the onset of treatment. Severe underweight at initial diagnosis was significantly associated with more frequent ED. When relapse was included as a competing risk, cumulative incidence of death in CR1 were 5.9%, 5.0%, and 4.6% for ANLL97, AML15, and DB01, respectively (P = NS). The most important cause of TRM included infectious and SCT‐related complications. Conclusion We report relatively stable rates of ED and TRM in CR1 in the latest completed DCOG protocols for newly diagnosed AML patients. The most important causes of TRM were SCT‐ or infection‐related, warranting further evaluation and awareness.