Presentation acuity, induction mortality, and resource utilization in infants with acute leukemia

• Type of Material: Article
• Authors: Azada Ibrahimova, Einstein Healthcare Network Philadelphia; Lena E Winestone, UCSF Benioff Childrens Hosp; Tamara Miller, Emory University; Kyle Kettler, Drexel University; Alix E Seif, Childrens Hospital of Philadelphia; Yuan-Shung Huang, Childrens Hospital of Philadelphia; Caitlin W Elgarten, Childrens Hospital of Philadelphia; Regina M Myers, Childrens Hospital of Philadelphia; Brian T Fisher, Childrens Hospital of Philadelphia; Richard Aplenc, Childrens Hospital of Philadelphia; Kelly D Getz, Childrens Hospital of Philadelphia
• Language: English
• Date: 2021-03-11
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wiley Periodicals LLC
• Final Published Version (URL): http://dx.doi.org/10.1002/pbc.28940
• Title of Journal or Parent Work: PEDIATRIC BLOOD & CANCER
• Volume: 68
• Issue: 7
• Start Page: e28940
• End Page: e28940
• Grant/Funding Information: Kelly D. Getz receives support for research effort from a NHLBI career development grant (5K01HL143153) and an Alex’s Lemonade Stand Foundation Young Investigator award. Lena E. Winestone, Regina M. Myers, and Caitlin W. Elgarten receive support for research effort from an Alex’s Lemonade Stand Foundation Young Investigator award. Tamara P. Miller receives support for research effort from a NCI career development grant (5K07CA211956).
• Keywords: Science & Technology; INFECTIOUS COMPLICATIONS; DOWN-SYNDROME; Hematology; ACUTE LYMPHOBLASTIC-LEUKEMIA; DEATH; AML; resource utilization; induction mortality; THERAPY; infant leukemia; FREESTANDING PEDIATRIC HOSPITALS; Oncology; CHILDRENS-ONCOLOGY-GROUP; Life Sciences & Biomedicine; ACUTE MYELOID-LEUKEMIA; PROGNOSTIC-FACTORS; Pediatrics

Abstract

Background: Treatment of infants with acute leukemia remains challenging, especially for acute lymphocytic leukemia (ALL). Infants have shown markedly higher rates of induction mortality compared with noninfants. There are limited data on presentation acuity and supportive care utilization in this age group. Methods: In retrospective analyses of patients treated for new onset ALL or acute myeloid leukemia (AML) at pediatric hospitals contributing to the Pediatric Health Information System, we compared presentation acuity, induction mortality, and resource utilization in infants relative to noninfants less than 10 years at diagnosis. Results: Analyses included 10 359 children with ALL (405 infants, 9954 noninfants) and 871 AML (189 infants, 682 noninfants). Infants were more likely to present with multisystem organ failure compared to noninfants for both ALL (12% and 1%, PR = 10.8, 95% CI: 7.4, 15.7) and AML (6% vs. 3%; PR = 2.0, 95% CI: 1.0, 3.7). Infants with ALL had higher induction mortality compared to noninfants, even after accounting for differences in anthracycline exposure and presentation acuity (2.7% vs. 0.5%, HR = 2.1, 95% CI: 1.0, 4.8). Conversely, infants and noninfants with AML had similar rates of induction mortality (3.2% vs. 2.1%, HR = 1.2, 95% CI: 0.3, 3.9), which were comparable to rates among infants with ALL. Infants with ALL and AML had greater requirements for blood products, diuretics, supplemental oxygen, and ventilation during induction relative to noninfants. Conclusions: Infants with leukemia present with higher acuity compared with noninfants. Induction mortality and supportive care requirements for infants with ALL were similar to all children with AML, and significantly higher than those for noninfants with ALL.