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Cancer Med. 2019 Aug;8(9):4454-4464. doi: 10.1002/cam4.2337. Epub 2019 Jun 12.

Quality of life in pediatric acute myeloid leukemia: Report from the Children's Oncology Group.

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Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
The Children's Oncology Group, Monrovia, California.
Division of Biostatistics, University of Southern California, Los Angeles, California.
Division of Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Oncology, AI Dupont, Wilmington, Delaware.
Division of Oncology, Seattle Children's Hospital, Seattle, Washington.
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario.



Objectives were used to describe guardian proxy-report and child self-report quality of life (QoL) during chemotherapy for pediatric acute myeloid leukemia (AML) patients.


Patients enrolled on the phase 3 AML trial AAML1031 who were 2-18 years of age with English-speaking guardians were eligible. Instruments used were the PedsQL Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. Assessments were obtained at the beginning of Induction 1 and following completion of cycles 2-4. Potential predictors of QoL included the total number of nonhematological grade 3-4 Common Terminology Criteria for Adverse Event (CTCAE) submissions.


There were 505 eligible guardians who consented to participate and 348 of their children provided at least one self-report assessment. The number of submitted CTCAE toxicities was significantly associated with worse physical health summary scores (β ± standard error (SE) -3.00 ± 0.69; P < 0.001) and general fatigue (β ± SE -2.50 ± 0.66; P < 0.001). Older age was significantly associated with more fatigue (β ± SE -0.58 ± 0.25; P = 0.022). Gender, white race, Hispanic ethnicity, private insurance status, risk status, bortezomib assignment, and duration of neutropenia were not significantly associated with QoL.


The number of CTCAE toxicities was the primary factor influencing QoL among children with AML. Reducing toxicities should improve QoL; identifying approaches to ameliorate them should be a priority.


acute myeloid leukemia; fatigue; patient-reported outcome; pediatric; quality of life

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