Patient and hospital factors associated with induction mortality in acute lymphoblastic leukemia.

TitlePatient and hospital factors associated with induction mortality in acute lymphoblastic leukemia.
Publication TypeJournal Article
Year of Publication2014
AuthorsSeif AE, Fisher BT, Li Y, Torp K, Rheam DP, Huang YS, Harris T, Shah A, Hall M, Fieldston ES, Kavcic M, Vujkovic M, L Bailey C, Kersun LS, Reilly AF, Rheingold SR, Walker DM, Aplenc R
JournalPediatr Blood Cancer
Date Published2014 May
KeywordsAdolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Hospital Mortality, Hospitals, Pediatric, Humans, Infant, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Prognosis, Respiration, Artificial, Retrospective Studies, Risk Factors, Socioeconomic Factors, Tertiary Care Centers, Young Adult

BACKGROUND: Deaths during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL) account for one-tenth of ALL-associated mortality and half of ALL treatment-related mortality. We sought to ascertain patient- and hospital-level factors associated with induction mortality.

PROCEDURE: We performed a retrospective cohort analysis of 8,516 children ages 0 to <19 years with newly diagnosed ALL admitted to freestanding US children's hospitals from 1999 to 2009 using the Pediatric Health Information System database. Induction mortality risk was modeled accounting for demographics, intensive care unit-level interventions, and socioeconomic status (SES) using Cox regression. The association of ALL induction mortality with hospital-level factors including volume, hospital-wide mortality and payer mix was analyzed with multiple linear regression.

RESULTS: ALL induction mortality was 1.12%. Race and patient-level SES factors were not associated with induction mortality. Patients receiving both mechanical ventilation and vasoactive infusions experienced nearly 50% mortality (hazard ratio 122.30, 95% CI 66.56-224.80). Institutions in the highest induction mortality quartile contributed 27% of all patients but nearly half of all deaths (47 of 95). Hospital payer mix was associated with ALL induction mortality after adjustment for other hospital-level factors (P = 0.046).

CONCLUSIONS: The overall risk of induction death is low but substantially increased in patients with cardio-respiratory and other organ failures. Induction mortality varies up to three-fold across hospitals and is correlated with hospital payer mix. Further work is needed to improve induction outcomes in hospitals with higher mortality. These data suggest an induction mortality rate of less than 1% may be an attainable national benchmark.

Alternate JournalPediatr Blood Cancer
PubMed ID24249480
PubMed Central IDPMC3951664
Grant List1 R01 CA133881-01 / CA / NCI NIH HHS / United States
1 R01CA133881-04 / CA / NCI NIH HHS / United States
P30 CA016520 / CA / NCI NIH HHS / United States
R01 CA133881 / CA / NCI NIH HHS / United States
R01 CA165277 / CA / NCI NIH HHS / United States