PMID- 30915498
OWN - NLM
STAT- MEDLINE
DCOM- 20190605
LR  - 20191210
IS  - 1432-0584 (Electronic)
IS  - 0939-5555 (Linking)
VI  - 98
IP  - 6
DP  - 2019 Jun
TI  - Survival and risk factors for mortality in pediatric patients with acute myeloid 
      leukemia in a single reference center in low-middle-income country.
PG  - 1403-1411
LID - 10.1007/s00277-019-03661-7 [doi]
AB  - Despite advances in therapy and care for children with acute myeloid leukemia 
      (AML), survival rates for children in low- and middle-income countries (LMICs) 
      remain poor. We studied risk factors for mortality and survival in children with 
      AML in a LMIC to develop strategies to improve survival for AML children in these 
      countries. This retrospective cohort (2000-2014) analyzed newly diagnosed AML 
      patients (age < 19 years) at a reference center in Brazil. Demographic and 
      clinical variables were reviewed by AML subtype: acute promyelocytic leukemia 
      (APL), AML with Down syndrome (AML-DS), and other AML subtypes. Cumulative hazard 
      risk for early death (ED) until 6 weeks of treatment and risk factors for 
      mortality were determined by the multivariate Cox hazard models. Survival was 
      assessed for each AML subtypes. A total of 220 patients were diagnosed: APL 50 
      (22.7%), AML-DS 16 (7.3%), and other AML subtypes 154 (70.0%). The cumulative 
      hazard function values for ED for all patients with AML were 12.5% (95% CI 
      8.5-18.4%); for each AML patients subtypes: APL, 21.7% (95% CI 11.7-40.5%); 
      AML-DS, 6.2% (95% CI 0.9-44.4%); and other AML subtypes, 10.2% (95% CI 
      6.2-17.0%). White blood cell count (cutoff 10 x 10(9)/L for APL and 100 x 10(9)/L 
      for other AML subtypes) and Afro-descendance were significant risk factors for 
      mortality in APL and other AML subtypes, respectively. Overall survival for 
      patients with APL, AML-DS, and other AML subtypes was 66.8%, 62.5%, and 38.0%, 
      respectively. APL patients had the highest incidence of ED and those with other 
      subtypes had increased relapse risk. We also observed high rates of death in 
      complete remission mainly due to infection. Better risk classification and 
      identification of risk factors for infection may improve the survival of these 
      patients.
FAU - Lins, Mecneide Mendes
AU  - Lins MM
AD  - Pediatric Oncology Unit, Instituto de Medicina Integral Prof. Fernando Figueira, 
      Recife, PE, Brazil.
FAU - Mello, Maria Julia Goncalves
AU  - Mello MJG
AUID- ORCID: 0000-0003-4645-8343
AD  - Pediatric Research Center, Instituto de Medicina Integral Prof. Fernando 
      Figueira, Rua dos Coelhos, 300 Boa Vista, Recife, PE, 50070-550, Brazil. 
      mjuliagmello@gmail.com.
FAU - Ribeiro, Raul C
AU  - Ribeiro RC
AD  - Department of Oncology and Global Pediatric Medicine, St. Jude Children's 
      Research Hospital, Memphis, TN, USA.
AD  - Department of Pediatrics, University of Tennessee Health Science Center, Memphis, 
      TN, USA.
FAU - De Camargo, Beatriz
AU  - De Camargo B
AD  - Research Center, Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
FAU - de Fatima Pessoa Militao de Albuquerque, Maria
AU  - de Fatima Pessoa Militao de Albuquerque M
AD  - Departamento de Saude Coletiva (Collective Health Department) of CPqAM, FIOCRUZ, 
      Recife, Brazil.
FAU - Thuler, Luiz Claudio Santos
AU  - Thuler LCS
AD  - Research Center, Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
LA  - eng
PT  - Journal Article
DEP - 20190326
PL  - Germany
TA  - Ann Hematol
JT  - Annals of hematology
JID - 9107334
SB  - IM
MH  - Adolescent
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Brazil/epidemiology
MH  - Child
MH  - Child, Preschool
MH  - Comorbidity
MH  - Developing Countries
MH  - Down Syndrome/epidemiology
MH  - Female
MH  - Humans
MH  - Income
MH  - Infant
MH  - Infections/mortality
MH  - Leukemia, Myeloid, Acute/drug therapy/economics/ethnology/*mortality
MH  - Leukemia, Promyelocytic, Acute/drug therapy/mortality
MH  - Male
MH  - Proportional Hazards Models
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - AML
OT  - Acute promyelocytic leukemia
OT  - Children
OT  - Low- and middle-income countries
OT  - Risk factor
OT  - Survival
EDAT- 2019/03/28 06:00
MHDA- 2019/06/06 06:00
CRDT- 2019/03/28 06:00
PHST- 2018/10/31 00:00 [received]
PHST- 2019/03/06 00:00 [accepted]
PHST- 2019/03/28 06:00 [pubmed]
PHST- 2019/06/06 06:00 [medline]
PHST- 2019/03/28 06:00 [entrez]
AID - 10.1007/s00277-019-03661-7 [pii]
AID - 10.1007/s00277-019-03661-7 [doi]
PST - ppublish
SO  - Ann Hematol. 2019 Jun;98(6):1403-1411. doi: 10.1007/s00277-019-03661-7. Epub 2019 
      Mar 26.