Oskarsson T, et al. - This trial incorporated the exploration of how treatment-related toxicity affected the survival in relapsed childhood acute lymphoblastic leukemia (ALL). It was determined that fatal treatment complications contributed considerably to the poor overall survival after relapse. Hence, the implementation of novel therapies with reduced toxicity and aggressive supportive care management were found to be crucial for improving the survival in relapsed childhood ALL.

Methods

• The scheme of this research was a retrospective population-based study.
• Herein, the causes of death were elucidated along with an estimation of the risk for treatment-related mortality in patients with first relapse of childhood ALL in the Nordic Society of Paediatric Haematology and Oncology ALL-92 and ALL-2000 trials.

Results

• Among the 483 patients who received relapse treatment with curative intent, 52 patients (10.8%) who died of treatment-related causes were identified.
• Death was reported in 12 of these died before achieving second remission and 40 died in second remission.
• In 38 patients (73.1%), infections were determined as the cause of death, predominantly bacterial infections during the chemotherapy phases of the relapse treatment.
• The occurrence of viral infections were more common following hematopoietic stem cell transplantation (HSCT) in second remission.
• The data revealed the following as independent risk factors for treatment-related mortality: High-risk stratification at relapse (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.3-3.9; P < 0.01), unfavorable cytogenetic aberrations (HR 3.4; 95% CI 1.3-9.2; P=0.01), and HSCT (HR 4.64; 95% CI 2.17-9.92; P < 0.001).
• Contrary to previous findings, no statistically prominent sex or age differences were detected.
• It was unveiled that none of the 17 patients with Down syndrome died of treatment-related causes.