Severe Toxicity during Chemotherapy Treatment for Pediatric Acute Myeloid Leukemia
Notice bibliographique
Résumé
Treatment for pediatric acute myeloid leukemia (AML) is highly intensive, and thus almost all patients will experience severe toxicities, which are often life-threatening. In 5–10% of patients, treatment for pediatric AML is fatal. To minimize the adverse effects of treatment, identification and characterization of risk factors for severe toxicity is important. Furthermore, toxic and leukemic responses could be related, and it is likely that toxic response is associated with treatment outcome. The focus of this thesis is to describe the severe toxicities occurring during pediatric AML treatment, investigate potential risk factors and describe prophylactic measures and their safety. In addition, we aimed to investigate how toxicity and risk factors for toxicity are related to treatment outcome. The studies in the thesis are based on three different cohorts. Study I is based on a cohort of children diagnosed with AML in the five Nordic countries and Hong Kong. For study II, the cohort was expanded to include children diagnosed in the Netherlands, Belgium, Canada, and the USA. The cohort for studies III and IV was the same: Children diagnosed with AML in the Nordic countries, Hong Kong, Belgium, and the Netherlands. In study I, we found that 90% of children had experienced grade 3–4 toxicities. Overweight and older age were associated with increased risk of severe toxicity. In study II, we found no significant differences in risk of relapse and death for four bodymass index (BMI) groups, in contrast to previous reports. Obesity was associated with core binding factor AML. In study III, we found that time to neutrophil recovery after the first induction course was associated with time to neutrophil recovery after the remaining courses. Furthermore, longer time to neutrophil recovery after the first induction course was associated with increased risk of microbiologically documented infection and increased risk of relapse. In study IV, we found that use of granulocyte colony-stimulating factor (G-CSF) as supportive care was frequent in the cohort, but decreased with time. Use of G-CSF was associated with an increased risk of relapse. Severe acute toxicities, especially infections, are a large problem in the treatment of pediatric AML and measures for prevention are limited. The studies in this thesis have brought further insight into severe toxicities occurring during treatment for pediatric AML, which will be important knowledge in the attempt to minimize the treatment burden in the future.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».