Induction mortality, ATRA administration, and resource utilization in a nationally representative cohort of children with acute promyelocytic leukemia in the United States from 1999 to 2009.

TitleInduction mortality, ATRA administration, and resource utilization in a nationally representative cohort of children with acute promyelocytic leukemia in the United States from 1999 to 2009.
Publication TypeJournal Article
Year of Publication2014
AuthorsFisher BT, Singh S, Huang YS, Li Y, Gregory J, Walker D, Seif AE, Kavcic M, Aplenc R
JournalPediatr Blood Cancer
Volume61
Issue1
Pagination68-73
Date Published2014 Jan
ISSN1545-5017
KeywordsAdolescent, Antineoplastic Agents, Child, Child, Preschool, Cohort Studies, Databases, Factual, Female, Health Resources, Humans, Induction Chemotherapy, Leukemia, Promyelocytic, Acute, Male, Tretinoin, Young Adult
Abstract

BACKGROUND: Limited data exist on induction mortality of pediatric patients with acute promyelocytic leukemia in the United States, usage of all-trans retinoic acid (ATRA) during acute promyelocytic leukemia induction, and the resources needed to deliver induction therapy.

PROCEDURE: Using the Pediatric Health Information System database we established a retrospective cohort of patients treated for newly diagnosed acute promyelocytic leukemia with ATRA between January 1999 and September 2009 in 32 of 43 PHIS contributing free-standing pediatric hospitals in the United States. Standard statistical methods were used to determine in-hospital induction mortality, ATRA administration, and resource utilization during a 60-day observation period.

RESULTS: A total of 163 children were identified who met eligibility criteria for cohort inclusion; 52% were female and 76% were white with an average age of 12.7 years. A total of 12 patients (7.4%) died, with 7 (58.3%) dying within the first 7 days of first admission. The mean time to first ATRA exposure increased with decreasing age (P = 0.0016). Resource utilization for management of retinoic acid syndrome was higher than anticipated based on prior studies and differed significantly from patients with non-M3 acute myeloid leukemia.

CONCLUSIONS: The induction mortality for pediatric acute promyelocytic leukemia remains substantial with wide variation in ATRA administration and high rates of resource utilization.

DOI10.1002/pbc.24585
Alternate JournalPediatr Blood Cancer
PubMed ID23868668
PubMed Central IDPMC3927454
Grant ListP30 CA016520 / CA / NCI NIH HHS / United States
R01 CA133881 / CA / NCI NIH HHS / United States
R01CA165277 / CA / NCI NIH HHS / United States