Association of Age with Acuity and Severity of Illness at Initial Presentation and with Overall Survival in Children, Adolescents, and Young Adults with Leukemia Pubblico
Jain, Tarun (Summer 2024)
Abstract
Background: Adolescent and Young Adult (AYA) patients (ages 15-39 years) with leukemia are at a higher risk for mortality than younger patients. The acuity of illness and its impact on mortality in AYA versus younger patients has been understudied. Objectives: To determine the association of age at diagnosis with acuity or severity of illness and with overall survival in patients presenting with new diagnoses of leukemia. Methods: We performed a retrospective analysis of a cohort of patients aged 1-21 years who presented with leukemia to Children’s Healthcare of Atlanta between 2010-2018. High acuity of illness was defined as any intensive care unit resource use in the first 72 hours following presentation (yes/no). High severity of illness was defined as having either an initial white blood cell count ≥ 50,000 cells/microliter or central nervous system disease (yes/no). Multivariable logistic regression was used to estimate the association of age with acuity or severity of illness, controlling for sex, race/ethnicity, insurance, and leukemia type. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression models to estimate the association between age and survival. We also conducted a mediation analysis to test the extent to which acuity and severity can explain the age differences in survival. Results: The median age of the cohort (N=688) was 6 years (interquartile range 3-12 years; 65.7% aged 1-9 years, 34.3% aged 10-21 years), 53.8% were male, 48.1% were non-Hispanic White, and 41.9% had private insurance. In considering the National Cancer Institute (NCI) age parameters for AYA, 15.1% of patients were 15-21 years. Diagnoses included B-cell acute lymphoblastic leukemia (ALL) (68.3%), AML (16.7%), T-cell ALL (10.8%), and other leukemias (4.2%). High acuity of illness at initial presentation was seen in 24.7% of patients, and high severity of illness at initial presentation was seen in 38.1% of patients. Patients aged 10 and older were more likely than those younger to have high acuity of illness at initial presentation (adjusted odds ratio [OR]) for 10-21 years versus 1-9 years: 1.94, 95% confidence interval [CI]): 1.32-2.85). Age at diagnosis was not significantly associated with high severity of illness (adjusted OR for 10-21 years versus 1-9 years: 1.25, 95% CI: 0.88-1.78). High acuity at initial presentation, but not high severity, was associated with a higher risk of death (hazard ratio of death for high acuity versus low acuity at 6 months post-diagnosis: 3.44, 95% CI: 1.51-7.85). High acuity explained 23% (95% CI: 2–44%) of the survival differences by age group at 6 months. Conclusion: Patients ≥ 10 years of age were more likely than younger patients to present with high acuity of illness, and high acuity was significantly associated with increased mortality. While the causality between age, biology of leukemia, and acuity of illness is not clear, this research is a step toward informing potential for strategies in child health toward narrowing age disparities in leukemia outcomes.
Table of Contents
INTRODUCTION: 1
LITERATURE REVIEW: 4
METHODS: 12
RESULTS: 21
DISCUSSION:27
REFERENCES: 35
TABLES AND FIGURES: 38
APPENDIX: 53
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Association of Age with Acuity and Severity of Illness at Initial Presentation and with Overall Survival in Children, Adolescents, and Young Adults with Leukemia () | 2024-07-01 13:48:46 -0400 |
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