Rubnitz Jeffrey E, Lensing Shelly, Zhou Yinmei, Sandlund John T, Razzouk Bassem I, Ribeiro Raul C, Pui Ching-Hon
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
Cancer. 2004 Oct 1;101(7):1677-84. doi: 10.1002/cncr.20532.
Despite improvements in supportive care, death due to treatment toxicity remains a significant problem for children treated for acute leukemia.
To determine the causes of and risk factors for death unrelated to refractory leukemia, to disease recurrence, or to second malignancy, the authors reviewed the records of 1011 patients with acute lymphoblastic leukemia (ALL) and 260 patients with acute myeloid leukemia (AML) treated between 1984 and 1999 and between 1983 and 2002, respectively, at St. Jude Children's Research Hospital (Memphis, TN). Data for patients who underwent stem cell transplantation were censored at the time of transplantation.
For patients with ALL, the estimated 10-year cumulative incidence of death was 2.9% +/- 5.3%. Age was the only predictor of death. Patients with ALL 1-9 years old had a significantly lower risk of death than did younger or older patients (P = 0.002). For patients with AML, the estimated 5-year cumulative incidence of death was 7.6% +/- 1.9%. Increasing age and increasing leukocyte count were significantly associated with increased risk of death. For patients with ALL and with AML, the incidence of death remained relatively constant during the time periods studied. Infection was the most common cause of death.
In the current study, the authors determined that children > or = 10 years of age are at increased risk of death during therapy for ALL and AML.
尽管支持治疗有所改善，但对于接受急性白血病治疗的儿童而言，治疗毒性导致的死亡仍是一个重大问题。
为了确定与难治性白血病、疾病复发或二次恶性肿瘤无关的死亡原因及危险因素，作者回顾了分别于1984年至1999年以及1983年至2002年期间在圣裘德儿童研究医院（田纳西州孟菲斯）接受治疗的1011例急性淋巴细胞白血病（ALL）患者和260例急性髓细胞白血病（AML）患者的记录。接受干细胞移植的患者的数据在移植时进行了审查。
对于ALL患者，估计的10年累积死亡率为2.9%±5.3%。年龄是唯一的死亡预测因素。1至9岁的ALL患者的死亡风险明显低于年龄较小或较大的患者（P = 0.002）。对于AML患者，估计的5年累积死亡率为7.6%±1.9%。年龄增加和白细胞计数增加与死亡风险增加显著相关。对于ALL和AML患者，在研究期间死亡率保持相对稳定。感染是最常见的死亡原因。
在当前研究中，作者确定年龄≥10岁的儿童在ALL和AML治疗期间死亡风险增加。
Zotero 插件