Long term survival in children with acute leukaemia and complications requiring mechanical ventilation
- Daniel Steinbach1,
- Bernhard Wilhelm1,
- Hans-Rudolf Kiermaier1,
- Ursula Creutzig2,
- Martin Schrappe3,
- Martin Zimmermann4,
- Klaus-Michael Debatin1,
- Bernd Gruhn5,
- Arend von Stackelberg6,
- Heribert Jürgens2,
- Brigitte Strahm7,
- Dirk Reinhardt4,
- Anja Möricke3
- 1Children's Hospital, University of Ulm, Ulm, Germany
- 2Children's Hospital, University of Münster, Münster, Germany
- 3Children's Hospital, University of Kiel, Kiel, Germany
- 4Children's Hospital, University of Hannover, Hannover, Germany
- 5Children's Hospital, University of Jena, Jena, Germany
- 6Children's Hospital, Humboldt-University Berlin, Berlin, Germany
- 7Children's Hospital, University of Freiburg, Freiburg, Germany
- Correspondence to Professor Daniel Steinbach, Children's Hospital, University Children's Hospital Ulm, Eythstrasse 24, 89075 Ulm, Germany; .
- Accepted 2 June 2011
- Published Online First 29 June 2011
Objective Previous reports have indicated that the short term prognosis for patients with malignant diseases and serious adverse events requiring mechanical ventilation (SAEV) is improving. The purpose of this study was to determine whether these patients can be cured of malignant disease or whether they survive SAEV only to subsequently relapse.
Patients and methods The authors report the outcome of children with SAEV treated in the multicentre studies ALL-BFM 95 and AML-BFM 98. Data from 1182 patients with acute lymphoblastic leukaemia (ALL) and 334 patients with acute myeloid leukaemia (AML) were analysed. 88 patients (51 ALL and 37 AML) developed SAEV.
Results The prognosis was almost identical in ALL and AML patients (survival of SAEV patients: 48%, 95% CI 38% to 58%; overall survival after 5 years: 31%, 95% CI 21% to 41%). Prognosis was independent of the time between leukaemia diagnosis and SAEV. Approximately 20% of children who required haemodialysis (n=14) or cardiac resuscitation (n=16) achieved long term survival, but no patient who fulfilled more than three of six identified risk factors (age ≥10 years, high risk leukaemia, C reactive protein ≥150 mg/l, administration of inotropic infusion, cardiac resuscitation and haemodialysis) survived (n=16; 0%, 95% CI 0% to 20%).
Conclusions Intensive care improves the short and long term survival of children with leukaemia. 64% (95% CI 50% to 78%) of children with acute leukaemia who survived SAEV achieved long term survival. Prognosis mainly depends on age and leukaemia risk group.
DR and AM contributed equally to this work
Competing interests None.
Ethics approval This study was conducted with the approval of the Ethics Committee of the Universities of Hannover and Münster.
Provenance and peer review Not commissioned; externally peer reviewed.