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- Title
Supportive care utilization and treatment toxicity in children with Down syndrome and acute lymphoid leukaemia at free-standing paediatric hospitals in the United States.
- Authors
Salazar, Elizabeth G.; Li, Yimei; Fisher, Brian T.; Rheingold, Susan R.; Fitzgerald, Julie; Seif, Alix E.; Huang, Yuan‐Shung; Bagatell, Rochelle; Aplenc, Richard
- Abstract
Although inferior outcomes of children with Down syndrome ( DS) and acute lymphoid leukaemia ( ALL) are established, national supportive care patterns for these patients are unknown. A validated retrospective cohort of paediatric patients diagnosed with ALL from 1999 to 2011 was assembled from the US Pediatric Health Information System ( PHIS) database to examine organ toxicity, sepsis, and resource utilization in children with and without DS. Among 10699 ALL patients, 298 had DS- ALL (2·8%). In a multivariate model, DS was associated with increased risk of cardiovascular (odds ratio [ OR] 2·0, 95% confidence interval [ CI] 1·6-2·7), respiratory ( OR 2·1, 95% CI: 1·6-2·9), neurologic ( OR 3·4, 95% CI 1·9-6·2), and hepatic ( OR 1·4, 95% CI 1·0-1·9) dysfunction and sepsis ( OR 1·8, 95% CI: 1·4-2·4). Children with DS- ALL used significantly more respiratory support, insulin, and anti-infectives, including broad-spectrum Gram-positive agents, quinolones, and azoles. They used significantly fewer analgesics and antiemetics compared to non- DS- ALL children. Ultimately, this study confirms the increased risk of infectious and end-organ toxicity in children with DS- ALL and quantifies important differences in resource utilization between children with DS and non- DS ALL. These findings highlight the importance of investigating the impact of these care variations and developing specific supportive care guidelines for this population.
- Subjects
DOWN syndrome; LEUKEMIA; QUINOLONE antibacterial agents; CARDIOVASCULAR diseases risk factors; SEPSIS
- Publication
British Journal of Haematology, 2016, Vol 174, Issue 4, p591
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/bjh.14085