Early Deaths Before or During the Induction Phase in Children with Acute Myelocytic Leukemia (Aml) in Two Different Periods 1979-1985 and 1986-1996
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2022 Rogelio Paredes-Aguilera, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abstract
To assess the incidence, clinical and laboratory spectrum of early deaths before or during the induction phase of treatment in patients with AML, we conducted a retrospective study in 69 patients enrolled in protocol AML I of the Hematology Department at the Instituto Nacional de Pediatría, Mexico City, between 1979-1985. Thirty patients (40.8%) died in the first six weeks after diagnosis, before treatment was initiated or a result of treatment-related complications. Thirteen patients (18.8%) died before treatment, eight of them (61.5%) in the first 24 hours and five (38.4%) during the first week of admission, mainly severe thrombocytopenia and FAB subtypes AML M-3 and M-4, M-5 were the main risk factors. Fifty-six patients received the induction phase of treatment and seventeen patients (30.3%) died before remission was reached as a result of treatment-related complications and the predominant cause of death were infections, particularly bacterial infections which occurred in 14 patients (82.3%); risk factor for death during induction was mainly sepsis, although hemorrhage was a frequent symptom as a terminal event, and active bleeding in conjunction with severe thrombocytopenia was the cause of death in 3 patients (17.6%). Seven (61%) out of the 17 patients who died on days 14-42 were FAB M-3 and 13 out of 23 (56.5%) patients with early death (first six weeks after diagnosis) had FAB M-3 subtype. In the second study (1986-1996 period) only 24 patients with FAB M-3 subtype were analyzed, Of the 24 patients, five (20.8%) died of ICH before receiving treatment and the principal risk factors were bleeding diathesis 5/5 (100%), DIC 5/5 (100%), 3 (60%) with overt DIC and 2 (40%) with low grade DIC and severe thrombocytopenia 5/5 (100%). Seven (36.8%) out of 19 patients died after day 15 of initiating induction phase of therapy and the cause of death was mainly sepsis particularly gram-negative microorganisms, in some cases in combination with active bleeding symptoms. Twelve (50%) out of 24 patients with FAB M-3 were ED. In conclusion the rates of early death before (18.8%) and during the induction phase of treatment (30.7%) in the early 1980s in children undergoing therapy for AML in our hospital were unacceptable high. There was also a high rate of early death before (20.8%) and during induction treatment (36.8%) in FAB M-3 subtype of AML in the following ten years period. The purpose of this article is to increase clinical awareness of risk factors for early death before treatment and in the first two weeks of induction treatment in developing countries, the need for better strategies of supportive care to minimize the risk of fatal complications d
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