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Therapy

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

Leukemia volume 19, pages 537–544 (2005)Cite this article

Abstract

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 counter-balanced 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.

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Acknowledgements

We would like to thank all patients and physicians participating in the Dutch Childhood Oncology Group studies.

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Authors and Affiliations

  1. Department of Pediatric Hematology/Oncology, VU University Medical Center, Amsterdam, The Netherlands

    A M Slats, A J P Veerman & C M Zwaan

  2. Department of Pediatric Oncology, Leiden University Medical Center, Leiden, The Netherlands

    R M Egeler

  3. Dutch Childhood Oncology Group, The Hague, The Netherlands

    R M Egeler, A van der Does-van den Berg, C Korbijn, K Hählen, W A Kamps, A J P Veerman & C M Zwaan

  4. Department of Pediatric Oncology/Hematology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands

    K Hählen

  5. Department of Pediatric Oncology, University Hospital Groningen, Groningen, The Netherlands

    W A Kamps

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  1. A M Slats
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Correspondence to C M Zwaan.

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Slats, A., Egeler, R., van der Does-van den Berg, A. et al. Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience. Leukemia 19, 537–544 (2005). https://doi.org/10.1038/sj.leu.2403665

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