Fifty five deaths between January, 1982 to September, 1989 in children with acute lymphoblastic leukemia (ALL) were evaluated to determine the cause of mortality. Fifty cases died during remission. Infection alone was responsible for death in 26 of 55 (47.3%) cases while hemorrhage was seen in 7 (12.7%) children. Infection and hemorrhage together were responsible in another 13 cases. Gastrointestinal tract and pulmonary system were the major sites of bleeding. Infections either alone or in combination with other factors were responsible for death in 42 of 55 (76.5%) of children. Septicemia (n = 11), gastrointestinal (n = 15) and pulmonary infections (n = 10) and meningitis in 2 cases were the major sites of infections. Pseudomonas and Klebsiella in 6 cases each accounted for 54.5% of isolates.
PIP: New developments in case management presently afford cures to more than 60% of children with acute lymphoblastic leukemia (ALL). 287 children diagnosed with ALL were admitted to the All India Institute of Medical Sciences over the period January, 1982 - September, 1989, where they began chemotherapy. 50 died during initial or subsequent induction therapy and 5 died during the maintenance phase. All deaths were subsequently reviewed to identify the causes of mortality. Infection alone caused death in 47.3% of cases, hemorrhage was observed among 12.7%, and infection together with hemorrhage killed another 13 children. Septicemia, gastrointestinal, and pulmonary infections in 11, 15, and 10 cases, respectively, and meningitis in 2 cases were major sites or infection. Pseudomonas and Klebsiella in 6 cases each accounted for 54.5% of isolates. The gastrointestinal tract and pulmonary system were major sites of bleeding. While no definite cause of death was found for 5 cases, infections nonetheless either alone or combined with other factors caused 76.5% of deaths. To improve the long-term event free survival of children with ALL, practitioners must be knowledgeable about the potential spectrum of infections, begin treatment early with appropriate antibiotics, and seek to improve the availability of supportive facilities and modern antibiotics.