1. ¹Department of Paediatric Haematology and Oncology, St Anna Children's Hospital, Vienna, Austria
2. ²Children's Cancer Research Institute , St Anna Children's Hospital, Vienna, Austria
3. ³Division of Paediatric Haematology and Oncology, Department of Paediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
4. ⁴Department of Paediatrics, Innsbruck Medical University, Innsbruck, Austria
5. ⁵Department of Paediatrics, Landeskinderklinik Linz, Linz, Austria

Correspondence: Dr G Mann, Department of Paediatric Haematology and Oncology, St Anna Children's Hospital, Kinderspitalgasse 6, Vienna A-1090, Austria. E-mail: georg.mann@stanna.at

Received 22 November 2008; Revised 7 January 2009; Accepted 12 January 2009; Published online 12 February 2009.

Abstract

In the management of the childhood acute lymphoblastic leukemia (ALL), 5% of failures are due to induction death and treatment-related deaths in first complete remission. We retrospectively analyzed the incidence, pattern and causes of death and its risk factors for 896 children with ALL enrolled into five Austrian (A) Berlin-Frankfurt-Münster (BFM) trials between 1981 and 1999. The estimated 10-year cumulative incidence of death significantly decreased from 61% (n=16/268) in trials ALL-BFM-A 81 and ALL-A 84 to 21% (n=15/628) in trials ALL-BFM-A 86, 90 and 95 (P=0.006). A significant reduction of death was evident during induction therapy (2.2% in trials ALL-BFM-A 81 and ALL-A 84 and 0.2% in trials ALL-BFM-A 86, 90 and 95, P=0.001). Of 31 patients, 21 (68%) patients died from infectious and 10 (32%) from noninfectious complications. Treatment in trial ALL-BFM-A 81, infant age and female gender were independent predictors of an enhanced risk for death. Conclusively, we found a progressive reduction of death rates that may be explained by the increasing experience in specialized hemato-oncologic centers and improved supportive and intensive care. We also identified a distinct subset of patients who are especially prone to death and may need a special focus when receiving intense chemotherapy.