2014-2017 RETROSPECTIVE STUDY ON THE ANALYSIS OF CAUSES OF DEATH, OTHER THAN DISEASE PROGRESSION, IN CHILDREN DIAGNOSED WITH ACUTE LYMPHOBLASTIC LEUKAEMIA – EXPERIENCE OF THE PAEDIATRIC DEPARTMENT OF FUNDENI CLINICAL INSTITUTE

Introduction. Acute lymphoblastic leukemia (ALL) is the most common form of cancer in the pediatric population (1). The survival rate has increased in recent years due to the continuous adjustment of therapeutic protocols (2). Despite all the efforts made alongside the evolution of new therapeutic protocols, the treatment related mortality (TRM) is around 2-4% in the Western European countries (3,4). Materials and methods. This retrospective is an analytical, observational and cohort-type study, the first of this kind in Romania, performed in a single pediatric hematology center, Clinical Institute Fundeni, between 2014 and 2017. It assesses the incidence of global mortality, the incidence of mortality due to any cause other than progression of disease (NRM = Non Relapse Mortality) and the main cause of death in children diagnosed with ALL. Results. We included 142 patients diagnosed between January 2014 and June 2017, with follow-up of 48 months post-diagnosis. The overall mortality of the cohort is 10.5% (15/142). The mortality rate for any other cause except disease progression (NRM) is 7.04% (10/15). These ten patients, in molecular remission, have as main cause of death complications that occurred during treatment (TRM= treatment related mortality with / without IRM = infection related mortality). The study showed increased percentages of IRM 6.3%, over value of other studies, explaining and increasing also the value of NRM and also the value of global mortality; In contrast to TRM 2.1%, this being in the reference range (12,17,19,20). The most common cause of NRM was Clostridium difficile infection (4/10). Conclusion. There are important to note the high percentage of achievement of complete remission (98%) and impressive global survival at 4 years (89.4%)