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Paediatric relapsed acute leukaemia: curative intent chemotherapy improves quality of life
  1. Carmen Salaverria1,
  2. Erin Plenert2,
  3. Roberto Vasquez1,
  4. Soad Fuentes-Alabi1,
  5. George A Tomlinson3 and
  6. Lillian Sung4
  1. 1Division of Hematology and Oncology, Hospital Nacional De Ninos Benjamin Bloom, San Salvador, El Salvador
  2. 2Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
  4. 4Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Lillian Sung, Division of Haematology/Oncology, The Hospital for Sick Children Department of Paediatrics, Toronto M5G 1X8, Ontario, Canada; lillian.sung{at}sickkids.ca

Abstract

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 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.

  • leukaemia
  • paediatrics
  • quality of life
  • supportive care
  • survivorship
  • symptoms and symptom management

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Footnotes

  • Contributors Development of protocol: all. Data collection: CS, EP, RV and SF-A. Analysis: GAT and LS. Drafting of manuscript: EP and LS. Critical revision of manuscript: all. Approval of manuscript: all.

  • Funding This research was funded by The Hospital for Sick Children’s Global Child Health Catalyst Grant.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Research Ethics Boards at Hospital Bloom (San Salvador) and The Hospital for Sick Children (Toronto).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available by reasonable request to the corresponding author.

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