Death analysis of childhood acute lymphoblastic leukaemia; experience at shaukat khanum memorial cancer hospital and research centre, pakistan

Objectives: To analyze the common causes of death in childhood Acute Lymphoblastic Leukaemia (ALL) patients during therapy at Paediatric Oncology Department of Shaukat Khanum Memorial Cancer Hospital. Methods: Retrospective descriptive study conducted at Paediatric Oncology department at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore Pakistan. All registered cases of ALL from 12 months to 18 years of age who expired between May 2001 to December 2005 were included. Mortality data was collected and analyzed regarding age, sex, WBC count, immunophenotype, treatment protocol, remission, and timing of death with respect to treatment protocol and the cause of death. Results: Out of 304 new cases of ALL registered in the study period, 74 (24%) died during treatment. During induction 39 of 74 (52.7%) died, 33 (44.5%) in first remission and 2 (2.8%) before initiation of therapy. Infection alone or in combination with other factors was responsible for deaths in 63 of 74 (85%) cases. Septicemia, pulmonary and gastrointestinal infections were documented in 37/63 (58.7%), 44/63 (69%) and 8/63 (12.6%) cases respectively. Eight (10.8%) died due to haemorrhage. Three (4%) deaths were secondary to chemotherapy induced toxicity. Conclusion: Infection is the major cause of mortality in ALL patients in our study population. To improve survival it is imperative to improve supportive care especially prevention and management of infection.