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Elements Associated With Early Mortality in Children With B Cell Acute Lymphoblastic Leukemia in Chiapas, Mexico

A Case-control Study

Lepe-Zuniga, Jose L., MD, DSci; Ramirez-Nova, Virginia, MD

Journal of Pediatric Hematology/Oncology: January 2019 - Volume 41 - Issue 1 - p 1–6
doi: 10.1097/MPH.0000000000001337
Original Articles

Childhood Lymphoblastic leukemia’s (ALL) early mortality (EM) is an undesirable treatment outcome for a disease for which >90% long term success is achievable. In the Western world EM constitutes no >3%; yet, in Chiapas, Mexico, remains around 15%. With the objective of improving on EM, we determined associated elements in 28 ALL who died within 60 days of arriving at Hospital de Especialidades Pediátricas in Chiapas (HEP), by comparing them to those in 84 controls who lived beyond the first 90 days. χ2, t test, and binary logistic regression (BLR) were used to determine significant individual and multiple variables associated to outcome. On arrival, fever, liver and spleen enlargement, active bleeding, lower albumin, less platelets, higher creatinine, and uric acid, more diploid and less hyperdiploid cases were associated with EM cases. Time to diagnosis, nutritional status, risk group and leukocyte count were not related. Antileukemic treatment approach was similar in both groups. The BLR model including fever, active bleeding, liver enlargement, <10,000 platelets/µL, and >2X upper normal lactic dehydrogenase, determined outcome in 66.7% EM and 90.2% controls. To improve on EM in ALL, patients with characteristics defined here ought to be treated differently at HEP.

Hospital de Especialidades Pediátricas, Chiapas, México

Supported by internal funds from the Hospital de Especialidades Pediátricas de Tuxtla Gutiérrez, Chiapas, Mexico.

The authors declare no conflict of interest.

Reprints: Jose L. Lepe-Zuniga, MD, DSci, Research Department, Hospital de Especialidades Pediátricas, Chiapas, SS Juan Pablo II S/N, Tuxtla Gutiérrez, Chiapas, CP 29070, México (e-mail:

Received November 6, 2017

Accepted September 18, 2018

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