Fatalities During Remission of Childhood Leukemia

The purpose of this study is to determine the frequency, causes, and circumstances of death during remission of childhood leukemia and to delineate predisposing or contributing factors. While overall mortality has decreased, the frequency of remission fatalities at this institution has increased progressively to l6% of all children dying with acute lymphocytic leukemia. This increase coincides with more aggressive therapy, longer remissions and survival, and a larger patient population at risk. The primary causes of death were nonbacterial infections in 23 of the 26 children. Pneumocystis carinii, herpesviruses, cytomegalovirus, and fungi were the principal microorganisms. All but two patients had received intensive combination chemotherapy, and 20 of 26 had received radiotherapy. All patients had experienced hematologic and other toxicity, but severe leukopenia and granulocytopenia did not correlate with the onset of terminal illness. A frequent side effect of therapy was failure to gain weight. Most patients had potentially fatal infections prior to the terminal illness. Despite complete clinical remission for at least 1 mo before death, leukemia was found at autopsy in nine of 20 patients.