BACKGROUND: The objectives of this study were to describe the incidence, timing, and predictors of treatment-related mortality (TRM) among children with acute lymphoblastic leukemia (ALL) in El Salvador, Guatemala, and Honduras. METHODS: Patients aged <20 years who were diagnosed with ALL between January 2000 and March 2008, who received treatment in any of the 3 countries, and who started induction chemotherapy were included in the study. Almost all patients were treated on the El Salvador-Guatemala-Honduras II protocol, which was based on the St. Jude Total XIII and XV protocols. Biologic, socioeconomic, and nutritional variables were examined as predictors of TRM. RESULTS: Of 1670 patients, TRM occurred as a first event in 156 children (9.3%); TRM occurred during remission induction therapy in 92 of 156 children (59%), between remission induction and maintenance therapy in 27 of 156 children (17%), and during maintenance therapy in 37 of 156 children (24%). Although the TRM rate decreased in patients who were diagnosed after July 1, 2004 (11.2% vs 7.9%; P = .02), the rate of induction death did not change (5.2% vs 5.8%; P = .58). Independent predictors of induction death included higher risk ALL (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.03-3.27; P = .04), lower initial platelet counts (OR per 10 × 10(9) /L, 0.94; 95% CI, 0.89-0.98; P = .005), and longer travel time to the clinic (OR, 1.06 per hour; 95% CI, 1.01-1.14; P = .03). CONCLUSIONS: In Central America, TRM remains an important cause of treatment failure in children with ALL. A large proportion of TRM occurs in maintenance, although this proportion has decreased over time. Supportive care interventions should especially target children who present with low platelet counts. Further study on transfusion ability and the location of induction deaths is required.
BACKGROUND: The objectives of this study were to describe the incidence, timing, and predictors of treatment-related mortality (TRM) among children with acute lymphoblastic leukemia (ALL) in El Salvador, Guatemala, and Honduras. METHODS:Patients aged <20 years who were diagnosed with ALL between January 2000 and March 2008, who received treatment in any of the 3 countries, and who started induction chemotherapy were included in the study. Almost all patients were treated on the El Salvador-Guatemala-Honduras II protocol, which was based on the St. Jude Total XIII and XV protocols. Biologic, socioeconomic, and nutritional variables were examined as predictors of TRM. RESULTS: Of 1670 patients, TRM occurred as a first event in 156 children (9.3%); TRM occurred during remission induction therapy in 92 of 156 children (59%), between remission induction and maintenance therapy in 27 of 156 children (17%), and during maintenance therapy in 37 of 156 children (24%). Although the TRM rate decreased in patients who were diagnosed after July 1, 2004 (11.2% vs 7.9%; P = .02), the rate of induction death did not change (5.2% vs 5.8%; P = .58). Independent predictors of induction death included higher risk ALL (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.03-3.27; P = .04), lower initial platelet counts (OR per 10 × 10(9) /L, 0.94; 95% CI, 0.89-0.98; P = .005), and longer travel time to the clinic (OR, 1.06 per hour; 95% CI, 1.01-1.14; P = .03). CONCLUSIONS: In Central America, TRM remains an important cause of treatment failure in children with ALL. A large proportion of TRM occurs in maintenance, although this proportion has decreased over time. Supportive care interventions should especially target children who present with low platelet counts. Further study on transfusion ability and the location of induction deaths is required.
Authors: William A Wood; Ruta Brazauskas; Zhen-Huan Hu; Hisham Abdel-Azim; Ibrahim A Ahmed; Mahmoud Aljurf; Sherif Badawy; Amer Beitinjaneh; Biju George; David Buchbinder; Jan Cerny; Laurence Dedeken; Miguel Angel Diaz; Cesar O Freytes; Siddhartha Ganguly; Usama Gergis; David Gomez Almaguer; Ashish Gupta; Gregory Hale; Shahrukh K Hashmi; Yoshihiro Inamoto; Rammurti T Kamble; Kehinde Adekola; Tamila Kindwall-Keller; Jennifer Knight; Lalit Kumar; Yachiyo Kuwatsuka; Jason Law; Hillard M Lazarus; Charles LeMaistre; Richard F Olsson; Michael A Pulsipher; Bipin N Savani; Kirk R Schultz; Ayman A Saad; Matthew Seftel; Sachiko Seo; Thomas C Shea; Amir Steinberg; Keith Sullivan; David Szwajcer; Baldeep Wirk; Jean Yared; Agnes Yong; Jignesh Dalal; Theresa Hahn; Nandita Khera; Carmem Bonfim; Yoshiko Atsuta; Wael Saber Journal: Biol Blood Marrow Transplant Date: 2018-03-19 Impact factor: 5.742
Authors: Jennifer L Pauley; John C Panetta; Kristine R Crews; Deqing Pei; Cheng Cheng; John McCormick; Scott C Howard; John T Sandlund; Sima Jeha; Raul Ribeiro; Jeffrey Rubnitz; Ching-Hon Pui; William E Evans; Mary V Relling Journal: Cancer Chemother Pharmacol Date: 2013-06-13 Impact factor: 3.333
Authors: Sheena Mukkada; Cristel Kate Smith; Delta Aguilar; April Sykes; Li Tang; Mae Dolendo; Miguela A Caniza Journal: Pediatr Blood Cancer Date: 2017-09-12 Impact factor: 3.167
Authors: Elva Jiménez-Hernández; Ethel Zulie Jaimes-Reyes; José Arellano-Galindo; Xochiketzalli García-Jiménez; Héctor Manuel Tiznado-García; María Teresa Dueñas-González; Octavio Martínez Villegas; Berenice Sánchez-Jara; Vilma Carolina Bekker-Méndez; María Guadalupe Ortíz-Torres; Antonio Ortíz-Fernández; Teresa Marín-Palomares; Juan Manuel Mejía-Aranguré Journal: Biomed Res Int Date: 2015-03-26 Impact factor: 3.411