Creutzig et al identified a number of risk factors associated with mortality in children with acute myeloid leukemia (AML). These can help identify children who may benefit from closer monitoring and more aggressive therapy. The authors are from University Children's Hospitals in Berlin, Frankfurt, Muenster, Hannover, Vienna and Prague.


Patient selection: pediatric patients <= 18 years of age with de novo AML


Exclusions: Down syndrome or extramedullary sarcoma with < 30% blasts in bone marrow


Mortality rate in study populations: almost 12%


Treatment periods during the 18 months once treatment started:

(1) induction

(2) high-dose cytarabine mitoxantrone

(3) consolidation with daunorubicin or idarubicin

(4) high-dose etoposide

(5) CNS radiation therapy and maintenance therapy


Causes of death during the first 15 days after diagnosis:

(1) bleeding

(2) leukostasis


Risk factors for death during first 15 days:

(1) poor performance status (ECOG 3 or 4)

(2) hyperleukocytosis (>= 200,000 per µL), usually indicating progressive disease

(3) AML type M5 (FAB classification)


Causes of death after first 15 days:

(1) bacterial infections

(2) fungal infections

(3) bleeding (occasional during induction and consolidation phases)


Risk factors for death after first 15 days:

(1) bone marrow aplasia during periods of chemotherapy


Reducing the risk to the patient:

(1) The patient should be managed at a specialized pediatric oncology center.

(2) Prophylaxis and early management of bleeding and infectious complications.

(3) Leukapheresis or exchange transfusion may be helpful in controlling hyperleukocytosis.


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