Salaverria Carmen, Plenert Erin, Vasquez Roberto, Fuentes-Alabi Soad, Tomlinson George A, Sung Lillian
Division of Hematology and Oncology, Hospital Nacional De Ninos Benjamin Bloom, San Salvador, El Salvador.
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2021 Jan 17. doi: 10.1136/bmjspcare-2020-002722.
Paediatric patients with leukaemia with relapse or induction failure have poor prognosis. Anticipated quality of life (QoL) is important in treatment decision making. The objective was to determine if curative intent at relapse or induction failure, when compared with palliative intent, was associated with child's physical health, pain or general fatigue and parents' QoL over time among patients with paediatric leukaemia in El Salvador.
This was a prospective observational cohort study. Children 2-18 years with acute leukaemia at first relapse or induction failure were eligible. Assessments occurred every 2 months for up to 2 years using validated proxy report and self-report scales, where guardians were the primary respondents. Initial curative or palliative intent was categorised at enrolment by physicians. The impact of initial intent on QoL was assessed using linear mixed effects models and interaction between QoL and time.
Of the 60 families enrolled, initial treatment intent was curative in 31 (51.7%) and palliative in 29 (48.3%). During the 2-year observation period, 44 children died. Initial curative intent significantly improved child's physical health (estimate=8.4, 95% CI 5.1 to 11.6), pain (estimate=5.4, 95% CI 1.5 to 9.2) and fatigue (estimate=6.6, 95% CI 3.2 to 9.9) compared with palliative intent, but not parents' QoL (estimate=1.0, 95% CI -0.8 to 2.8).
Among paediatric patients with acute leukaemia at relapse or induction failure, initial curative intent treatment plan was associated with better physical health, pain and fatigue when compared with palliative intent. A curative approach may be a reasonable option for patients with acute leukaemia even when prognosis is poor.
复发或诱导治疗失败的小儿白血病患者预后较差。预期生活质量（QoL）在治疗决策中很重要。目的是确定在萨尔瓦多小儿白血病患者中，复发或诱导治疗失败时的根治性治疗意图与姑息性治疗意图相比，是否与儿童的身体健康、疼痛或总体疲劳以及父母随时间的生活质量相关。
这是一项前瞻性观察队列研究。年龄在2至18岁、首次复发或诱导治疗失败的急性白血病儿童符合条件。使用经过验证的代理报告和自我报告量表，每2个月进行一次评估，为期2年，主要受访者为监护人。医生在入组时将初始治疗意图分为根治性或姑息性。使用线性混合效应模型以及生活质量与时间之间的相互作用来评估初始意图对生活质量的影响。
在入组的60个家庭中，初始治疗意图为根治性的有31个（51.7%），姑息性的有29个（48.3%）。在2年的观察期内，44名儿童死亡。与姑息性治疗意图相比，初始根治性治疗意图显著改善了儿童的身体健康（估计值=8.4，95%置信区间5.1至11.6）、疼痛（估计值=5.4，95%置信区间1.5至9.2）和疲劳（估计值=6.6，95%置信区间3.2至9.9），但对父母的生活质量没有影响（估计值=1.0，95%置信区间-0.8至2.8）。
在复发或诱导治疗失败的小儿急性白血病患者中，与姑息性治疗意图相比，初始根治性治疗意图的治疗方案与更好的身体健康、疼痛和疲劳相关。即使预后较差，根治性治疗方法对于急性白血病患者可能也是一个合理的选择。
