Pediatr Blood Cancer 2011;56:551–559 Risk Factors for Treatment Related Mortality in Childhood Acute Lymphoblastic

Background. In spite of major improvements in the cure rate of childhood acute lymphoblastic leukaemia (ALL), 2–4 % of patients still die from treatment related complications. Procedure. We inves-tigated the pattern of treatment related deaths (TRDs) and possible risk factors in the NOPHO ALL-92 and ALL-2000 protocols. Fifty-five TRDs were identified among the 1,645 ALL-92 patients and 33 among the 1,090ALL-2000 patients.Results. Therewas no significant difference in the incidence of TRDs between the two protocols (3.4% vs. 3.2%). Five patients died before initiation of therapy (0.2%), and the overall subsequent risk of induction death and death in first com-plete remission (CR1) was 1.2 % and 1.8%, respectively. Infections were the major cause of death comprising 72 % of all cases including 9 deaths from Pseudomonas aeruginosa and 11 deaths from fungal infections. Other causes of death included bleeding or thrombosis (eight patients), tumour burden related toxicities (seven patients) and organ toxicity (seven patients). Female gender (hazard ratio (HR): 2.2, 95 % confidence interval (95 % CI): 1.4–3.4), high white blood cell count (≥200×109/L) at diagnosis (HR: 3.5, 95 % CI: 1.7–7.1), T-cell disease (HR: 1.9, 95 % CI: 1.01–3.7), Down syndrome (HR: 7.3, 95% CI: 3.6–14.9) and haematopoietic stem cell transplantation in CR1 (HR: 8.0, 95 % CI: 3.3–19.5) were identified as independent risk fac-tors for TRD. Conclusion. Several TRDs were potentially preventable and future efforts should be directed towards patients at risk. Pediat