Department of Pediatrics and Adolescent Medicine, Einstein Healthcare Network Philadelphia, Philadelphia, Pennsylvania, USA.
Division of AIBMT, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California, USA.
Pediatr Blood Cancer. 2021 Jul;68(7):e28940. doi: 10.1002/pbc.28940. Epub 2021 Mar 11.
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.
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.
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.
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.
婴儿急性白血病的治疗仍然具有挑战性，尤其是急性淋巴细胞白血病（ALL）。与非婴儿相比，婴儿的诱导死亡率明显更高。在这个年龄段，关于表现的紧迫性和支持性护理的利用的数据有限。
在对参与儿科健康信息系统的儿科医院中治疗新发 ALL 或急性髓细胞白血病（AML）的患者进行回顾性分析中，我们比较了婴儿与诊断时小于 10 岁的非婴儿的表现紧迫性、诱导死亡率和资源利用。
分析包括 10359 例 ALL（405 例婴儿，9954 例非婴儿）和 871 例 AML（189 例婴儿，682 例非婴儿）。与非婴儿相比，ALL（12%与 1%，PR=10.8，95%CI：7.4，15.7）和 AML（6%与 3%；PR=2.0，95%CI：1.0，3.7）患儿更有可能出现多系统器官衰竭。即使考虑到蒽环类药物暴露和表现紧迫性的差异，ALL 婴儿的诱导死亡率也高于非婴儿（2.7%与 0.5%，HR=2.1，95%CI：1.0，4.8）。相反，AML 婴儿和非婴儿的诱导死亡率相似（3.2%与 2.1%，HR=1.2，95%CI：0.3，3.9），与 ALL 婴儿的死亡率相当。ALL 和 AML 婴儿在诱导期间对血液制品、利尿剂、补充氧气和通气的需求大于非婴儿。
与非婴儿相比，患有白血病的婴儿表现出更高的紧迫性。ALL 婴儿的诱导死亡率和支持性护理需求与所有 AML 儿童相似，明显高于 ALL 非婴儿。
