TY - JOUR
T1 - Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia
AU - Løhmann, Ditte J. A.
AU - Asdahl, Peter H.
AU - Abrahamsson, Jonas
AU - Ha, Shau-Yin
AU - Jónsson, Ólafur G.
AU - Kaspers, Gertjan J. L.
AU - Koskenvuo, Minna
AU - Lausen, Birgitte
AU - de Moerloose, Barbara
AU - Palle, Josefine
AU - Zeller, Bernward
AU - Hasle, Henrik
PY - 2018
Y1 - 2018
N2 - 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 × 109/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.
AB - 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 × 109/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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85050379081&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29781563
U2 - https://doi.org/10.1002/pbc.27231
DO - https://doi.org/10.1002/pbc.27231
M3 - Article
C2 - 29781563
SN - 1545-5009
VL - 65
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 9
M1 - e27231
ER -