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Introduction <p>Outcomes of Pediatric Leukemia in low- and middle-income countries (LMIC) lags behind that of high-income countries. Infection related mortality and lack of supportive care in the LMIC setting are a major hurdle in improving these outcomes. (Cardenas-Aguirre et al.,Front Oncol 30(12):1038879, 2022) We tried to understand the patterns of ICU admission and survival post ICU stay vis-a-vis type of leukemia and phase of treatment. One third of children with leukemia get admitted to the ICU for reasons such as sepsis, respiratory failure and other therapy related complications. The treatment for acute leukemia is divided into various phases such as induction, consolidation, maintenance, etc (Hughes et al., N Engl J Med 297:1419-26, 1977).&#xa0;Each phase has its unique implications.</p> Methods <p>Data was collected from Electronic Medical Records of patients 0 to 15 years of age, with suspected or confirmed diagnosis of AML, ALL or MPAL (mixed phenotype acute leukemia) admitted to the ICU from January 2022 to December 2022. ICU mortality and post discharge survival was calculated based on descriptive statistics. For the purpose of analysis, phase of treatment was divided into induction, consolidation and maintenance therapy for ALL; and Induction and consolidation for AML. Cause of admission and the severity of illness was recorded using Pediatric risk of mortality IV (PRISM IV) score.</p> Results <p>Among the 489 children with acute leukemia treated by the Pediatric Oncology unit at Tata Memorial Hospital over a period of one year, there were 197 ICU admissions for 171 children with ALL (133), MPAL (4) and AML (60). The most common cause of ICU admission was acute respiratory distress, and the most common cause of death was septic shock. </p> <p>Among the ICU admissions by diagnosis, 72/133 ALL admissions and 32/60 AML admissions were during the induction phase. PICU mortality was 32.99% (65/197) in our cohort. Mortality in ALL children was 33.08% (44/133) and 31.66% (19/60) in AML. During the induction phase, the mortality in ALL 34.72% (25/72) and in 40.62% (13/32) in AML.</p> Conclusion <p>About a third of the patients with acute leukemia required ICU admission at any given point in time. Two-thirds of critically ill children with leukemia survive ICU stay with provision of high-quality critical care. The general perception is that these children have poor outcomes, but this evidence suggests otherwise. The admission rate and mortality are higher during induction phase of treatment for both ALL and AML.</p> Trial registration <p>CTRI/2024/10/076080 Registered on 30/10/2024.</p> <p><a href="https://ctri.nic.in/Clinicaltrials/login.php">https://ctri.nic.in/Clinicaltrials/login.php</a></p> Graphical Abstract <p></p>

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Implications of phase of treatment at ICU admission in critically ill children with haematological malignancy

  • 期刊论文

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  • 发表日期：

    2025年8月13日

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  • Sudivya Sharma,
  • Shilpushp Bhosale,
  • Atul Kulkarni,
  • Nikita Kulaye,
  • Chetan Dhamne,
  • Jigeeshu Divatia

摘要

Introduction

Outcomes of Pediatric Leukemia in low- and middle-income countries (LMIC) lags behind that of high-income countries. Infection related mortality and lack of supportive care in the LMIC setting are a major hurdle in improving these outcomes. (Cardenas-Aguirre et al.,Front Oncol 30(12):1038879, 2022) We tried to understand the patterns of ICU admission and survival post ICU stay vis-a-vis type of leukemia and phase of treatment. One third of children with leukemia get admitted to the ICU for reasons such as sepsis, respiratory failure and other therapy related complications. The treatment for acute leukemia is divided into various phases such as induction, consolidation, maintenance, etc (Hughes et al., N Engl J Med 297:1419-26, 1977). Each phase has its unique implications.

Methods

Data was collected from Electronic Medical Records of patients 0 to 15 years of age, with suspected or confirmed diagnosis of AML, ALL or MPAL (mixed phenotype acute leukemia) admitted to the ICU from January 2022 to December 2022. ICU mortality and post discharge survival was calculated based on descriptive statistics. For the purpose of analysis, phase of treatment was divided into induction, consolidation and maintenance therapy for ALL; and Induction and consolidation for AML. Cause of admission and the severity of illness was recorded using Pediatric risk of mortality IV (PRISM IV) score.

Results

Among the 489 children with acute leukemia treated by the Pediatric Oncology unit at Tata Memorial Hospital over a period of one year, there were 197 ICU admissions for 171 children with ALL (133), MPAL (4) and AML (60). The most common cause of ICU admission was acute respiratory distress, and the most common cause of death was septic shock.

Among the ICU admissions by diagnosis, 72/133 ALL admissions and 32/60 AML admissions were during the induction phase. PICU mortality was 32.99% (65/197) in our cohort. Mortality in ALL children was 33.08% (44/133) and 31.66% (19/60) in AML. During the induction phase, the mortality in ALL 34.72% (25/72) and in 40.62% (13/32) in AML.

Conclusion

About a third of the patients with acute leukemia required ICU admission at any given point in time. Two-thirds of critically ill children with leukemia survive ICU stay with provision of high-quality critical care. The general perception is that these children have poor outcomes, but this evidence suggests otherwise. The admission rate and mortality are higher during induction phase of treatment for both ALL and AML.

Trial registration

CTRI/2024/10/076080 Registered on 30/10/2024.

https://ctri.nic.in/Clinicaltrials/login.php

Graphical Abstract