| Abstract: |
Clinical trials on childhood acute promyelocytic leukemia (APL) report early death (ED) rates of 3–8%, but predictors of thrombohemorrhagic (TH)-ED are not well understood. In a retrospective study, we aimed to determine the incidence and predictors of TH-ED in childhood APL. Data were analyzed from children and adolescents with t(15;17)-positive APL (n = 683) who started treatment with all-trans retinoic acid (ATRA) and chemotherapy in different international studies. Demographic data; initial white blood cell (WBC), peripheral blood (PB) blast, and platelet counts; hemoglobin value; coagulation parameters; morphologic variant (M3 or M3v); and induction details were analyzed. Early death was defined as death occurring within 30 days of presentation. The incidence of ED was 4.7% (32 of 683 patients). Predictors of TH-ED were identified by univariable and multivariable Cox proportional hazard regression analyses (n = 25). In univariable analysis, high WBC (>10 × 109/L) (P < 0.001) and high PB blast (>30 × 109/L) (P < 0.001), M3v (P < 0.01), and black ethnicity (P < 0.001) were independent predictors of TH-ED. In multivariable analysis, high WBC count (P < 0.01) and obesity (i.e., body mass index ≥95th percentile for age) (P = 0.03) were predictors of TH-ED. Initial high WBC counts and obesity are likely predictors of TH-ED in childhood APL. The efficacy of novel drugs for APL-associated coagulopathy or of frontline arsenic trioxide and ATRA combination regimens in reducing ED rates in childhood APL remains to be established. © 2017, Springer-Verlag GmbH Germany. |
| Keywords: |
adolescent; adult; cancer chemotherapy; child; preschool child; child, preschool; gene translocation; major clinical study; genetics; clinical trial; mortality; cytarabine; antineoplastic agent; bleeding; cohort analysis; risk factors; obesity; creatinine; hemoglobin; creatinine blood level; hemoglobin blood level; kidney failure; retrospective study; risk factor; age; cause of death; leukemia, promyelocytic, acute; blood; body mass; albumin; death; infant; infant, newborn; multicenter study; newborn; promyelocytic leukemia; thrombocyte count; translocation, genetic; immunophenotyping; sex difference; leukocyte count; childhood; children; bacterial infection; retinoic acid; ethnicity; central nervous system bleeding; chromosome 17; multiple organ failure; chorionic gonadotropin; predictors; respiratory failure; lung hemorrhage; central nervous system disease; chromosomes, human, pair 17; chromosomes, human, pair 15; tretinoin; cd56 antigen; albumin blood level; apl; disseminated intravascular coagulation; chromosome 15; disseminated intravascular clotting; early death; humans; human; male; female; priority journal; article; chemically induced; central nervous system thrombosisi; thrombohemorrhagic early death
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