Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia.

Autor: Løhmann DJA; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Asdahl PH; Department of Hematology, Aarhus University Hospital, Aarhus, Denmark., Abrahamsson J; Institution for Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden., Ha SY; Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong, China., Jónsson ÓG; Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland., Kaspers GJL; Department of Pediatrics, VU University Medical Center Amsterdam, and Dutch Childhood Oncology Group, The Hague, The Netherlands., Koskenvuo M; Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki, Finland., Lausen B; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., De Moerloose B; Department of Pediatrics, Ghent University Hospital, Ghent, Belgium., Palle J; Department of Woman´s and Children´s Health, Uppsala University, Uppsala, Sweden., Zeller B; Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway., Hasle H; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2018 Sep; Vol. 65 (9), pp. e27231. Date of Electronic Publication: 2018 May 21.
DOI: 10.1002/pbc.27231
Abstrakt: Background: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01.
Procedure: Newly diagnosed patients with AML with bone marrow blast <5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 10 9 /l. Linear and Cox regressions were used to investigate associations.
Results: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3-4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1-1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1-2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission.
Conclusion: Longer neutrophil recovery time after the first induction course was associated with grade 3-4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.
(© 2018 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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