Mortality in pediatric acute lymphoblastic leukemia in induction phase of chemotherapy at Hatyai Hospital
Keywords:
Acute lymphoblastic leukemia, mortality rate, induction phase, risk factors of recurrent seizures within 24 hoursAbstract
Background: Acute lymphoblastic leukemia is the most common cancer in children, accounting for 40 percent of Thai pediatric cancers. The overall 5-year survival rate has risen due to the use of intensive chemotherapy. The mortality rate is highest during the induction phase of chemotherapy.
Objective: To study the mortality rate and factors influencing mortality in induction phase of chemotherapy pediatric acute lymphoblastic leukemia patients at Hatyai Hospital.
Method: We performed a retrospective study, collecting data from the Hatyai Hospital database between August 2011 to April 2021. Patients aged under 15 years old who were newly diagnosed with acute lymphoblastic leukemia and treated with the Thai-POG chemotherapy protocols at Hatyai Hospital were included. The mortality rate, cause of death, and the factors associated with mortality during induction phase of chemotherapy were analyzed.
Results: A total of 197 patients were included in this study and 55% of them were male. The most common age range was 4-10 years old (43.7%).Common presentations were fever (79.2%), hepatomegaly (74.6%), lymphadenopathy (62.4%), splenomegaly (59.4%), and anemia (25.9%), respectively. The induction phase mortality rate was 14.7%, and infection was the most common cause of death (79.3%). Risk factors found to increase mortality during the induction phase included thrombocytopenia ≤ 20,000/cu.mm. increased risk by 3.65 times compared with patient platelet >20,000 (95% CI 1.15-11.60, p value 0.028), Invasive aspergillosis infection increased risk by 64.1 times compared with patients without invasive aspergillosis (95% CI 6.24-657.96, p value 0.001). Sepsis increased risk by 32.0 times compared with patient without sepsis (95% CI 7.77-132.17, p value 0.001)
Conclusion: The induction phase mortality rate was 14.7%, and the major cause of death was infection. Thrombocytopenia ≤ 20,000/cu.mm., invasive aspergillosis infection, and sepsis increased the risk of mortality in induction phase of chemotherapy in pediatric acute lymphoblastic leukemia patients at Hatyai Hospital.
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