Mortality Analysis in Children during Induction Therapy for Acute Lymphoblastic Leukemia

Objective: To find out the death rate and analyze the causes of death in children with Acute Lymphoblastic Leukemia (ALL) during induction chemotherapy. Patients & Methods: This cross-sectional study was conducted at Children Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad. All children ranging from 1-13 years of age, and diagnosed as ALL, registered at Children Hospital PIMS, from January 2014 to September 2015 were included in the study. All patients were treated with the BFM protocol. Mortality data during induction therapy was collected and analyzed including rate and cause of death. Results: Out of 48 newly diagnosed cases of ALL, 10 (20.8%) patients died during induction phase. So, the induction death rate in the study period was 20.8 %. Bleeding was observed in 5 (50%) patients and was thus the commonest cause of death, followed by sepsis which was observed in 4 (40%) patients. Tumor lysis syndrome was observed in 1 (10%) patient. CNS was the major site of bleeding. Conclusion: The death rate during induction therapy is high in our setup. The major cause of death in the present study was bleeding, followed by sepsis. High death rate in our study was attributed to failure to arrange platelet and blood transfusions, and increased rate of infections particularly in low income families. It is emphasized that supportive therapy in the form of platelets and blood transfusions should be given on urgent basis to the children who present with low platelet counts. A good antibiotic cover should be given to treat infections and most important aspect is that patient’s caretaker’s education regarding the patient care is ensured. Keyword