Analysis of early and treatment related deaths among children and adolescents with acute myeloid leukemia in Poland: 2005-2023

被引：0

作者：

Pawinska-Wasikowska, Katarzyna ^{[1
,2
]}

Czogala, Malgorzata ^{[1
,2
]}

Bukowska-Strakova, Karolina ^{[3
]}

Surman, Marta ^{[3
]}

Rygielska, Monika ^{[4
]}

Ksiazek, Teofila ^{[5
]}

Sadowska, Beata ^{[6
]}

Pac, Agnieszka ^{[7
]}

Skalska-Sadowska, Jolanta ^{[8
]}

Samborska, Magdalena ^{[8
]}

Wachowiak, Jacek ^{[8
]}

Ciebiera, Malgorzata ^{[9
,10
]}

Chaber, Radoslaw ^{[9
,10
]}

Tomaszewska, Renata ^{[11
,12
]}

Szczepanski, Tomasz ^{[11
,12
]}

Zielezinska, Karolina ^{[13
]}

Urasinski, Tomasz ^{[13
]}

Rodziewicz-Konarska, Anna ^{[14
]}

Kalwak, Krzysztof ^{[14
]}

Kozlowska, Marta ^{[15
]}

Irga-Jaworska, Ninela ^{[15
]}

Sikorska-Fic, Barbara ^{[16
]}

Chyzynski, Bartosz ^{[16
]}

Laguna, Pawel ^{[16
]}

Muszynska-Roslan, Katarzyna ^{[17
]}

Krawczuk-Rybak, Maryna ^{[17
]}

Deleszkiewicz, Paulina ^{[18
]}

Drabko, Katarzyna ^{[18
]}

Bobeff, Katarzyna ^{[19
]}

Mlynarski, Wojciech ^{[19
]}

Chodala-Grzywacz, Agnieszka ^{[20
]}

Karolczyk, Grazyna ^{[20
]}

Mycko, Katarzyna ^{[21
]}

Badowska, Wanda ^{[21
]}

Bartoszewicz, Natalia ^{[22
]}

Styczynski, Jan ^{[22
]}

Machnik, Katarzyna ^{[23
]}

Stolpa, Weronika ^{[24
]}

Mizia-Malarz, Agnieszka ^{[24
]}

Balwierz, Walentyna ^{[1
,2
]}

Skoczen, Szymon ^{[1
,2
]}

机构：

[1] Jagiellonian Univ Med Coll, Inst Pediat, Dept Pediat Oncol & Hematol, Krakow, Poland

[2] Univ Childrens Hosp Krakow, Dept Pediat Oncol & Hematol, Krakow, Poland

[3] Jagiellonian Univ Med Coll, Inst Pediat, Dept Clin Immunol, Krakow, Poland

[4] Univ Childrens Hosp, Dept Pediat Oncol & Hematol, Hematol Lab, Krakow, Poland

[5] Jagiellonian Univ Med Coll, Inst Pediat, Dept Mol Genet, Krakow, Poland

[6] Univ Childrens Hosp, Dept Pediat Oncol & Hematol, Cytogenet & Mol Genet Lab, Krakow, Poland

[7] Jagiellonian Univ Med Coll, Fac Med, Dept Epidemiol & Prevent Med, Krakow, Poland

[8] Poznan Univ Med Sci, Dept Pediat Oncol Hematol & Transplantol, Poznan, Poland

[9] Prov Hosp, Dept Radiol, Tarnobrzeg, Poland

[10] Univ Rzeszow, Inst Med Sci, Med Coll, Dept Pediat, Rzeszow, Poland

[11] Dept Pediat Hematol & Oncol, Zabrze, Poland

[12] Med Univ Silesia, Katowice, Poland

[13] Pomeranian Med Univ, Dept Pediat Hematooncol & Gastroenterol, Szczecin, Poland

[14] Wroclaw Med Univ, Clin Dept Pediat Bone Marrow Transplantat Oncol &, Wroclaw, Poland

[15] Med Univ Gdansk, Dept Pediat Hematol & Oncol, Gdansk, Poland

[16] Med Univ Warsaw, Dept Oncol Pediat Hematol Transplantol & Pediat, Warsaw, Poland

[17] Med Univ Bialystok, Dept Pediat Oncol & Hematol, Bialystok, Poland

[18] Med Univ Lublin, Dept Pediat Hematol Oncol & Transplantol, Lublin, Poland

[19] Med Univ Lodz, Dept Pediat Oncol & Hematol, Lodz, Poland

[20] Reg Polyclin Hosp Kielce, Dept Pediat Hematol & Oncol, Kielce, Poland

[21] Prov Childrens Hosp, Dept Pediat & Hematol & Oncol, Olsztyn, Poland

[22] Nicolaus Copernicus Univ Torun, Coll Medicum, Dept Pediat Hematol & Oncol, Bydgoszcz, Poland

[23] City Hosp, Dept Pediat Hematol & Oncol, Chorzow, Poland

[24] Med Univ Silesiaia, Upper Silesia Childrens Care Heatlh Ctr, Dept Pediat, Katowice, Poland

来源：

FRONTIERS IN PEDIATRICS | 2024年 / 12卷

关键词：

acute myeloid leukemia; early death; treatment related death; children; adolescents; TREATMENT-RELATED MORTALITY; HYPERLEUKOCYTOSIS; LEUKAPHERESIS; THERAPY; AML;

D O I：

10.3389/fped.2024.1482720

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background: A personalised approach to the treatment of acute myeloid leukemia (AML) in children and adolescents, as well as the development of supportive therapies, has significantly improved survival. Despite this, some patients still die before starting treatment or in an early phase of therapy before achieving remission. The study analysed the frequency, clinical features and risk factors for early deaths (ED) and treatment related deaths (TRD) of children and adolescents with AML. Methods: From January 2005 to November 2023, 646 children with AML treated in the centers of the Polish Pediatric Leukemia and Lymphoma Study Group according to three subsequent therapeutic protocols were evaluated: AML-BFM 2004 Interim (385 children), AML-BFM 2012 Registry (131 children) and AML-BFM 2019 (130 children). Results: Out of 646 children, early death occurred in 30 children, including 15 girls. The median age was 10.7 years (1 day to 18 years). More than half of the patients (53%) were diagnosed with acute myelomonocytic leukemia (M5) and 13% with acute promyelocytic leukemia (M3). The ED rate for the three consecutive AML-BFM protocols was 4.9% vs. 5.3% vs. 3.1%, respectively. In 19 patients, death occurred before the 15th day of treatment, in 11 between the 15th and 42nd day. The most common cause of death before the 15th day (ED15) was leukostasis and bleeding, whereas between the 15th and 42nd day (ED15-42), infections, mainly bacterial sepsis. A significant association was found between ED15 and high leukocyte count (>10 x 10(9)/L), M3 leukemia (p < 0.001), and ED15-42 and age <1 year (p = 0.029). In the univariate analysis only initial high leukocyte count >100 x 10(9)/L, was a significant predictor of early death. The overall TRD for the entire study period was 3.4%. The main cause of death were infections, mainly bacterial sepsis (10 children out of 22, 45.4%). Conclusions: Hyperleukocytosis remains significant factor of early mortality in patients with AML, despite the introduction of various cytoreductive methods. Infections are still the main cause of treatment related deaths. A more individualized approach by using new targeted drugs may be the therapeutic option of choice in the future.

引用

页数：11

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