Quantifying the difference in risk of adverse events by induction treatment regimen in pediatric acute lymphoblastic leukemia.
Zachary E WestSharon M CastellinoCaitlin MonroeAmanda S ThomasCourtney McCrackenTamara P MillerPublished in: Leukemia & lymphoma (2020)
The differences in overall morbidity by induction treatment regimen for pediatric acute lymphoblastic leukemia (ALL) are unknown. We examined a cohort of children with ALL who received induction chemotherapy between January 2010 and May 2018. We evaluated 20 clinically relevant adverse events (AEs) and readmission and ICU admission rates. Outcomes were compared between standard 3- and 4-drug treatment regimens in multivariate analyses using Cox proportional hazard ratios. Among 486 eligible patients, the risks of sepsis (HR = 2.16, 95% CI = 1.11-4.19), hypoxia (HR = 2.08, 95% CI = 1.03-4.18), hyperbilirubinemia (HR = 2.48, 95% CI = 1.07-5.74), hyperglycemia (HR = 2.65, 95% CI = 1.29-5.42), thromboembolic event (HR = 4.50, 95% CI = 1.30-15.6), and hyponatremia (HR = 7.88, 95% CI = 1.26-49.4) were significantly higher during 4-drug induction. Despite no differences in readmission or ICU admission rates, 4-drug induction patients had greater total inpatient days (12 vs. 4 days; p<.0001). In conclusion, pediatric patients receiving 4-drug induction for ALL experience higher morbidity. These results inform care practices and patient guidance during induction therapy.
Keyphrases
- chronic kidney disease
- end stage renal disease
- acute lymphoblastic leukemia
- intensive care unit
- emergency department
- primary care
- type diabetes
- squamous cell carcinoma
- stem cells
- ejection fraction
- oxidative stress
- mental health
- adipose tissue
- case report
- adverse drug
- peritoneal dialysis
- prognostic factors
- mesenchymal stem cells
- newly diagnosed
- metabolic syndrome
- pain management
- acute myeloid leukemia
- quality improvement
- climate change
- weight loss
- patient reported outcomes
- acute respiratory distress syndrome
- locally advanced
- human health