Paediatric relapsed acute leukaemia
curative intent chemotherapy improves quality of life
Keywords:
What was already known?, Pediatric acute leukemia patients with relapse or induction failure living in low and middle income countries have a poor prognosis, Anticipated quality of life is central to therapeutic decision making when the prognosis is poor. What are the new findings?, Children treated with initial curative intent at relapse or induction failure had significantly better child physical health, less pain and less fatigue compared to those treated with initial palliative intent treatment plan, Parent quality of life was similar between those treated with initial curative vs. initial palliative intent therapy. What is their significance?, Initial curative intent therapy was associated with better child quality of life when compared with initial palliative intent therapy for pediatric patients with relapsed or induction failure acute leukemia, A curative approach may be a reasonable option for patients with acute leukemia even when the prognosis is poorAbstract
Objectives. Paediatric patients with leukaemia with relapse or induction failure have poor prognosis. Anticipated quality of life (QoL) is important in treatment decision making. The objective was to determine if curative intent at relapse or induction failure, when compared with palliative intent, was associated with child’s physical health, pain or general fatigue and parents’ QoL over time among patients with paediatric leukaemia in El Salvador Methods.. This was a prospective observational cohort study. Children 2–18 years with acute leukaemia at first relapse or induction failure were eligible. Assessments occurred every 2 months for up to 2 years using validated proxy report and self-report scales, where guardians were the primary respondents. Initial curative or palliative intent was categorised at enrolment by physicians. The impact of initial intent on QoL was assessed using linear mixed effects models and interaction between QoL and timeMethods.. This was a prospective observational cohort study. Children 2–18 years with acute leukaemia at first relapse or induction failure were eligible. Assessments occurred every 2 months for up to 2 years using validated proxy report and self-report scales, where guardians were the primary respondents. Initial curative or palliative intent was categorised at enrolment by physicians. The impact of initial intent on QoL was assessed using linear mixed effects models and interaction between QoL and time Results. Of the 60 families enrolled, initial treatment intent was curative in 31 (51.7%) and palliative in 29 (48.3%). During the 2-year observation period, 44 children died. Initial curative intent significantly improved child’s physical health (estimate=8.4, 95% CI 5.1 to 11.6), pain (estimate=5.4, 95% CI 1.5 to 9.2) and fatigue (estimate=6.6, 95% CI 3.2 to 9.9) compared with palliative intent, but not parents’ QoL (estimate=1.0, 95% CI −0.8 to 2.8). Conclusions. Among paediatric patients with acute leukaemia at relapse or induction failure, initial curative intent treatment plan was associated with better physical health, pain and fatigue when compared with palliative intent. A curative approach may be a reasonable option for patients with acute leukaemia even when prognosis is poor.
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