from Part IV - Complications and supportive care
Published online by Cambridge University Press: 01 July 2010
Introduction
The most common cause of early treatment failure among patients with childhood leukemia is death due to acute complications of the leukemia itself or its initial treatment. Despite the increasing intensity of treatment for acute lymphoblastic leukemia (ALL) in children, improvements in supportive care have reduced the rate of death due to acute complications from 10% in the early 1970s to less than 2% in the 1990s, and these improvements have had an important impact on event-free survival estimates for these patients. In fact, studies of the Medical Research Council (MRC) found that the rate of treatment-related death among children with ALL decreased from 9% in the 1980s (UKALL VIII trial) to 2% in the 1990s (UKALL X and XI trials). Hence, the 6% improvement in the 5-year event-free survival estimate during the same period (from 55% to 61%) can be attributed largely to advances in supportive care. The rate of toxic death associated with therapy for acute myeloid leukemia (AML) and relapsed ALL has also decreased over time but remains unacceptably high at 10% or greater in many studies. In countries with limited resources, death from toxicity accounts for more cases of treatment failure than does relapse in both AML and ALL.
Acute complications include “early” complications (those occurring within the first 2 weeks of therapy) and “on-therapy” complications (those occurring after the first 2 weeks of therapy). “Late” complications are those occurring after recovery from the final dose of chemotherapy (Table 29.1).
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.