Treatment‐related mortality in children with acute lymphoblastic leukemia in Central America

Abstract

BACKGROUND:The objectives of this study were to describe the incidence, timing, and predictors of treatmentrelated 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 ¼ .02), the rate of induction death did not change (5.2% vs 5.8%; P ¼ .58). Independent predictors of induction death included higher risk ALL (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.03-3.27; P ¼ .04), lower initial platelet counts (OR per 10 Â 10

Incidence and consequences of varicella in children treated for cancer in Guatemala

“…[2][3][4][5][6][7] As the largest contributor to TRM, infectious complications such as varicella have a greater impact on outcomes and costs of pediatric cancer in LMIC. [2][3][4][5][6][7] Varicella-zoster virus (VZV) infection causes significant morbidity and mortality in immunecompromised children, including those undergoing treatment for cancer. [9][10][11] Previous studies have reported the risk of disseminated infection in these patients, in the absence of prophylaxis or treatment with acyclovir, to be approximately 32%-50%.…”

“…[1] Compared with children in high-income countries (HIC), children in LMIC are disproportionately affected by treatment-related mortality (TRM), defined as death due to adverse effects of treatment rather than disease progression. [2][3][4][5][6][7][8] In children with acute lymphoblastic leukemia (ALL), TRM has been estimated to be in the range of 11-21% in LMIC, compared with 1-3% in HIC. [2][3][4][5][6][7] As the largest contributor to TRM, infectious complications such as varicella have a greater impact on outcomes and costs of pediatric cancer in LMIC.…”

“…[2][3][4][5][6][7][8] In children with acute lymphoblastic leukemia (ALL), TRM has been estimated to be in the range of 11-21% in LMIC, compared with 1-3% in HIC. [2][3][4][5][6][7] As the largest contributor to TRM, infectious complications such as varicella have a greater impact on outcomes and costs of pediatric cancer in LMIC. [2][3][4][5][6][7] Varicella-zoster virus (VZV) infection causes significant morbidity and mortality in immunecompromised children, including those undergoing treatment for cancer.…”

Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia

“…Vitamin B12 deficiency has also been associated with disordered hematopoiesis and dysfunctional immune response leading to increased susceptibility to infections [11]. Most of the deaths seen in children from the developing countries undergoing treatment for ALL occur during the initial phases of treatment due to infections and intolerance to chemotherapy [12,13]. Studies investigating the nutritional factors behind this poor outcome are scarce.…”

Relapse-free Rate with Childhood Acute Lymphoblastic Leukemia Treated under the Thai National Protocol

“…The possible risks were (a) children aged older than 10 years and (b) those with a CNS disease at diagnosis (Bajel et al, 2008;Silverman et al, 2011). Immunophenotype did not significantly affect the relapse-free rate as in other studies (Gupta et al, 2011). It may be that patients with high risk disease had a greater chance of disease recurrence; however, our risk stratification criteria were not strictly clarified since the molecular abnormalities of the host were not included.…”