REMISSION DEATH IN ACUTE LYMPHOBLASTIC-LEUKEMIA - A CHANGING PATTERN

The pattern of remission deaths was examined in 842 children with acut e lymphoblastic leukaemia (ALL) treated at a single centre over 18 yea rs. The mortality rate from leukaemia fell significantly during three consecutive time periods during which treatment became progressively m ore intensive and that during remission induction fell from 3.5% to un der 1%, but the rate of death in remission stayed constant at 5.6%. Th e factors associated with an increased risk of remission death were: y oung age, a higher leucocyte count, bone marrow transplantation, and D own's syndrome. The pattern of remission deaths changed over the years ; measles and herpes viruses decreased while deaths associated with pe riods of intensification and gut toxicity increased. Four children dev eloped second neoplasms. Treatment of ALL is still associated with a s ignificant risk of death in remission but the pattern of infective dea ths has changed. Many should be avoidable by provision of adequate sup portive care, close supervision after periods of intensive treatment, and appropriate antibiotic, antifungal, and cytokine therapy.