Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia

Ditte J. A. Løhmann, Peter H. Asdahl, Jonas Abrahamsson, Shau-Yin Ha, Ólafur G. Jónsson, Gertjan J. L. Kaspers, Minna Koskenvuo, Birgitte Lausen, Barbara de Moerloose, Josefine Palle, Bernward Zeller, Henrik Hasle

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. Procedure: Newly diagnosed patients with AML with bone marrow blast <5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 109/l. Linear and Cox regressions were used to investigate associations. Results: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3–4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1–1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1–2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. Conclusion: Longer neutrophil recovery time after the first induction course was associated with grade 3–4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.
Original languageEnglish
Article numbere27231
JournalPediatric Blood and Cancer
Volume65
Issue number9
DOIs
Publication statusPublished - 2018

Cite this

Løhmann, D. J. A., Asdahl, P. H., Abrahamsson, J., Ha, S-Y., Jónsson, Ó. G., Kaspers, G. J. L., ... Hasle, H. (2018). Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia. Pediatric Blood and Cancer, 65(9), [e27231]. https://doi.org/10.1002/pbc.27231
Løhmann, Ditte J. A. ; Asdahl, Peter H. ; Abrahamsson, Jonas ; Ha, Shau-Yin ; Jónsson, Ólafur G. ; Kaspers, Gertjan J. L. ; Koskenvuo, Minna ; Lausen, Birgitte ; de Moerloose, Barbara ; Palle, Josefine ; Zeller, Bernward ; Hasle, Henrik. / Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia. In: Pediatric Blood and Cancer. 2018 ; Vol. 65, No. 9.
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title = "Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia",
abstract = "Background: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. Procedure: Newly diagnosed patients with AML with bone marrow blast <5{\%} between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 109/l. Linear and Cox regressions were used to investigate associations. Results: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3–4 infections (hazard ratio 1.4, 95{\%} confidence interval [CI], 1.1–1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48{\%} vs. 42{\%}, hazard ratio 1.7, 95{\%} CI, 1.1–2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. Conclusion: Longer neutrophil recovery time after the first induction course was associated with grade 3–4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.",
author = "L{\o}hmann, {Ditte J. A.} and Asdahl, {Peter H.} and Jonas Abrahamsson and Shau-Yin Ha and J{\'o}nsson, {{\'O}lafur G.} and Kaspers, {Gertjan J. L.} and Minna Koskenvuo and Birgitte Lausen and {de Moerloose}, Barbara and Josefine Palle and Bernward Zeller and Henrik Hasle",
year = "2018",
doi = "10.1002/pbc.27231",
language = "English",
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journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
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Løhmann, DJA, Asdahl, PH, Abrahamsson, J, Ha, S-Y, Jónsson, ÓG, Kaspers, GJL, Koskenvuo, M, Lausen, B, de Moerloose, B, Palle, J, Zeller, B & Hasle, H 2018, 'Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia' Pediatric Blood and Cancer, vol. 65, no. 9, e27231. https://doi.org/10.1002/pbc.27231

Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia. / Løhmann, Ditte J. A.; Asdahl, Peter H.; Abrahamsson, Jonas; Ha, Shau-Yin; Jónsson, Ólafur G.; Kaspers, Gertjan J. L.; Koskenvuo, Minna; Lausen, Birgitte; de Moerloose, Barbara; Palle, Josefine; Zeller, Bernward; Hasle, Henrik.

In: Pediatric Blood and Cancer, Vol. 65, No. 9, e27231, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia

AU - Løhmann, Ditte J. A.

AU - Asdahl, Peter H.

AU - Abrahamsson, Jonas

AU - Ha, Shau-Yin

AU - Jónsson, Ólafur G.

AU - Kaspers, Gertjan J. L.

AU - Koskenvuo, Minna

AU - Lausen, Birgitte

AU - de Moerloose, Barbara

AU - Palle, Josefine

AU - Zeller, Bernward

AU - Hasle, Henrik

PY - 2018

Y1 - 2018

N2 - Background: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. Procedure: Newly diagnosed patients with AML with bone marrow blast <5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 109/l. Linear and Cox regressions were used to investigate associations. Results: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3–4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1–1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1–2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. Conclusion: Longer neutrophil recovery time after the first induction course was associated with grade 3–4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.

AB - Background: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. Procedure: Newly diagnosed patients with AML with bone marrow blast <5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 109/l. Linear and Cox regressions were used to investigate associations. Results: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3–4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1–1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1–2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. Conclusion: Longer neutrophil recovery time after the first induction course was associated with grade 3–4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29781563

U2 - 10.1002/pbc.27231

DO - 10.1002/pbc.27231

M3 - Article

VL - 65

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

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