Causes of death -: other than progressive leukemia -: in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML):: the Dutch Childhood Oncology Group experience
Causes of death -: other than progressive leukemia -: in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML):: the Dutch Childhood Oncology Group experience
复制标题
DOI：
10.1038/sj.leu.2403665
复制
发表时间：
2005-04-01
期刊：
影响因子：
11.4
通讯作者：
Zwaan, CM
中科院分区：
文献类型：
--
作者：
Slats, AM;Egeler, RM;Zwaan, CM
我们分析了875名急性淋巴细胞白血病（ALL）和229名急性髓细胞白血病（AML）儿童的死亡原因，而不是耐药疾病或复发，这些儿童接受了三种不同的荷兰儿童肿瘤组（DCOG）ALL和三种AML方案的治疗。总体而言，23例（2.6%）ALL和44例（19.2%）AML患者死亡。急性淋巴细胞白血病（ALL）9例（1%）和急性髓细胞白血病（AML）30例（13.1%）发生早期死亡（艾德，在达到缓解前）患者，包括三个和十个在治疗开始前死亡。9例ALL（1.1%）和8例AML（4.4%）患者发生缓解期化疗相关死亡（CRM）。对于ALL，艾德和CRM均随时间推移而下降，但无统计学显著性。对于AML，观察到艾德降低（从26%降至约10%），但被CRM增加（从3%增至8%）抵消，这可能与AML-92/94中强化治疗区组的时间安排有关。包括移植相关死亡率在内，AML中CR死亡率在上一项研究中从3%增加到15%。艾德的主要病因是出血，常伴有高白细胞血症，CRM的主要病因是感染。我们的结论是，ALL的死亡率有利下降，但AML的死亡率却没有下降。特别是对于AML，需要开发有效但毒性较小的治疗和更好的支持性护理指南。
We analyzed causes of death, other than resistant disease or relapse, in 875 children with acute lymphoblastic leukemia ( ALL) and 229 with acute myeloid leukemia (AML), treated on three different Dutch Childhood Oncology Group (DCOG) ALL and three AML protocols. Overall, 23 (2.6%) ALL and 44 (19.2%) AML patients died. Early death (ED, before remission was reached) occurred in nine ALL (1%) and thirty AML (13.1.%) patients, including three and ten deaths before treatment was initiated. Chemotherapy-related mortality in remission (CRM) occurred in nine ALL (1.1%) and eight AML (4.4%) patients. For ALL, both ED and CRM declined over time, although this was not statistically significant. For AML a decrease in ED was observed ( from 26% to approximately 10%), but counterbalanced by an increase in CRM ( from 3 to 8%), maybe related to the scheduling of intensification blocks in AML-92/94. Including transplant-related mortality, death in CR rates in AML increased from 3 to 15% in the last study. The main cause of ED was hemorrhage, often associated with hyperleucocytosis, and infection for CRM. We conclude that mortality dropped favorably in ALL, but not in AML. Especially for AML, effective but less toxic therapy and better supportive care guidelines need to be developed.