Induction mortality and resource utilization in children treated for acute myeloid leukemia at free-standing pediatric hospitals in the United States.

TitleInduction mortality and resource utilization in children treated for acute myeloid leukemia at free-standing pediatric hospitals in the United States.
Publication TypeJournal Article
Year of Publication2013
AuthorsKavcic M, Fisher BT, Li Y, Seif AE, Torp K, Walker DM, Huang YS, Lee GE, Tasian SK, Vujkovic M, Bagatell R, Aplenc R
JournalCancer
Volume119
Issue10
Pagination1916-23
Date Published05/2013
ISSN1097-0142
KeywordsAdolescent, Antineoplastic Combined Chemotherapy Protocols, Child, Child, Preschool, Cohort Studies, Cytarabine, Daunorubicin, Dexamethasone, Etoposide, Female, Health Resources, Hospitals, Pediatric, Humans, Induction Chemotherapy, Infant, Leukemia, Myeloid, Acute, Logistic Models, Male, Odds Ratio, Poisson Distribution, Risk Assessment, Risk Factors, Thioguanine, Treatment Outcome, United States
Abstract

BACKGROUND: Clinical trials in pediatric acute myeloid leukemia (AML) determine induction regimen standards. However, these studies lack the data necessary to evaluate mortality trends over time and differences in resource utilization between induction regimens. Moreover, these trials likely underreport the clinical toxicities experienced by patients.

METHODS: The Pediatric Health Information System database was used to identify children treated for presumed de novo AML between 1999 and 2010. Induction mortality, risk factors for induction mortality, and resource utilization by induction regimen were estimated using standard frequentist statistics, logistic regression, and Poisson regression, respectively.

RESULTS: A total of 1686 patients were identified with an overall induction case fatality rate of 5.4% that decreased from 9.8% in 2003 to 2.1% in 2009 (P = .0023). The case fatality rate was 9.0% in the intensively timed DCTER (dexamethasone, cytarabine, thioguanine, etoposide, and rubidomycin [daunomycin]/idarubicin) induction and 3.8% for ADE (cytarabine, daunomycin, and etoposide) induction (adjusted odds ratio = 2.2, 95% confidence interval = 1.1-4.5). Patients treated with intensively timed DCTER regimens had significantly greater antibiotic, red cell/platelet transfusion, analgesic, vasopressor, renal replacement therapy, and radiographic resource utilization than patients treated with ADE regimens. Resource utilization was substantially higher than reported in published pediatric AML clinical trials.

CONCLUSIONS: Induction mortality for children with AML decreased significantly as ADE use increased. In addition to higher associated mortality, intensively timed DCTER regimens had a correspondingly higher use of health care resources. Using resource utilization data as a proxy for adverse events, adverse event rates reported on clinical trials substantially underestimated the clinical toxicities of all pediatric AML induction regimens.

DOI10.1002/cncr.27957
Alternate JournalCancer
PubMed ID23436301
PubMed Central IDPMC3648620
Grant ListL40 CA142226 / CA / NCI NIH HHS / United States
R01 CA133881 / CA / NCI NIH HHS / United States
R01 CA165277 / CA / NCI NIH HHS / United States
R01CA165277 / CA / NCI NIH HHS / United States
T32 CA128583 / CA / NCI NIH HHS / United States
T32 HD044331 / HD / NICHD NIH HHS / United States