PMID- 15514380
OWN - NLM
STAT- MEDLINE
DCOM- 20041202
LR  - 20220408
IS  - 0732-183X (Print)
IS  - 0732-183X (Linking)
VI  - 22
IP  - 21
DP  - 2004 Nov 1
TI  - Early deaths and treatment-related mortality in children undergoing therapy for 
      acute myeloid leukemia: analysis of the multicenter clinical trials AML-BFM 93 
      and AML-BFM 98.
PG  - 4384-93
AB  - PURPOSE: The rates of early death (ED) and treatment-related mortality (TRM) are 
      unacceptably high in children undergoing intensive chemotherapy for acute myeloid 
      leukemia (AML). Better strategies of supportive care might help to improve 
      overall survival in these children. PATIENTS AND METHODS: In a retrospective 
      study, we analyzed incidence, clinical features, and risk factors for lethal 
      complications of 901 children enrolled onto the multicenter trials Acute Myeloid 
      Leukemia-Berlin-Frankfurt-Muenster (AML-BFM) 93 and AML-BFM 98. RESULTS: One 
      hundred four patients (11.5%) enrolled onto the clinical trials AML-BFM 93 and 
      AML-BFM 98 died shortly after diagnosis or as a result of treatment-related 
      complications. Thirty-two patients (3.5%) died before (six patients) or during 
      (26 patients) the first 14 days of treatment, mainly as a result of bleeding or 
      leukostasis. Low performance status, hyperleukocytosis, and 
      French-American-British type M5 were the main risk factors for a lethal event 
      before day 15. After day 15, the predominant causes of death were complications 
      caused by infections, particularly bacterial and fungal infections. The incidence 
      of lethal infections was highest during induction therapy and decreased 
      thereafter. When comparing both clinical trials, significantly fewer patients 
      died within the first 6 weeks in AML-BFM 98 than in AML-BFM 93 (14 [3.5%] of 430 
      patients v 35 [7.4%] of 471 patients; P = .01). CONCLUSION: To reduce the high 
      incidence of ED and TRM in children with AML, early diagnosis and adequate 
      treatment of complications are needed. Children with AML should be treated in 
      specialized pediatric cancer centers only. Prophylactic and therapeutic regimens 
      for better treatment management of bleeding disorders and infectious 
      complications have to be assessed in future trials to ultimately improve overall 
      survival in children with AML.
FAU - Creutzig, Ursula
AU  - Creutzig U
AD  - Department of Pediatric Hematology and Oncology, University Children's Hospital 
      Muenster, Albert-Schweitzer-Str 33, D-48129 Muenster, Germany. ursula@creutzig.de
FAU - Zimmermann, Martin
AU  - Zimmermann M
FAU - Reinhardt, Dirk
AU  - Reinhardt D
FAU - Dworzak, Michael
AU  - Dworzak M
FAU - Stary, Jan
AU  - Stary J
FAU - Lehrnbecher, Thomas
AU  - Lehrnbecher T
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
RN  - 04079A1RDZ (Cytarabine)
RN  - 143011-72-7 (Granulocyte Colony-Stimulating Factor)
RN  - 6PLQ3CP4P3 (Etoposide)
RN  - BZ114NVM5P (Mitoxantrone)
RN  - ZRP63D75JW (Idarubicin)
SB  - IM
MH  - Adolescent
MH  - Antineoplastic Combined Chemotherapy Protocols/*toxicity
MH  - Cause of Death
MH  - Chi-Square Distribution
MH  - Child
MH  - Child, Preschool
MH  - Cytarabine/administration & dosage/toxicity
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Etoposide/administration & dosage/toxicity
MH  - Female
MH  - Granulocyte Colony-Stimulating Factor/administration & dosage/toxicity
MH  - Humans
MH  - Idarubicin/administration & dosage/toxicity
MH  - Incidence
MH  - Infant
MH  - Infant, Newborn
MH  - Leukemia, Myeloid, Acute/*drug therapy/*mortality
MH  - Logistic Models
MH  - Male
MH  - Mitoxantrone/administration & dosage/toxicity
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
EDAT- 2004/10/30 09:00
MHDA- 2004/12/16 09:00
CRDT- 2004/10/30 09:00
PHST- 2004/10/30 09:00 [pubmed]
PHST- 2004/12/16 09:00 [medline]
PHST- 2004/10/30 09:00 [entrez]
AID - 22/21/4384 [pii]
AID - 10.1200/JCO.2004.01.191 [doi]
PST - ppublish
SO  - J Clin Oncol. 2004 Nov 1;22(21):4384-93. doi: 10.1200/JCO.2004.01.191.