Early death and treatment‐related mortality: A report from SUCCOUR ‐ Supportive Care for Children with Cancer in Africa

2021 ◽  
Author(s):  
Trijn Israels ◽  
Glenn Mbah Afungchwi ◽  
George Chagaluka ◽  
Peter Hesseling ◽  
Francine Kouya ◽  
...  
Keyword(s):  
Supportive Care ◽  
Early Death ◽  
Children With Cancer ◽  
Treatment Related Mortality ◽  
Related Mortality

scholarly journals Treatment-related mortality in children with cancer: Prevalence and risk factors

2019 ◽  
Vol 121 ◽  
pp. 113-122 ◽  
Author(s):  
Erik A.H. Loeffen ◽  
Rutger R.G. Knops ◽  
Joren Boerhof ◽  
E.A.M. (Lieke) Feijen ◽  
Johannes H.M. Merks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children With Cancer ◽  
Cancer Prevalence ◽  
Treatment Related Mortality ◽  
Related Mortality

scholarly journals The Treatment Related Mortality Score Predicts Early Adverse Events during Intensive Induction Chemotherapy for Acute Myeloid Leukemia (AML)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2276-2276
Author(s):  
Sarah A. Buckley ◽  
Megan Othus ◽  
Elihu H. Estey ◽  
Roland B. Walter
Keyword(s):  
Adverse Events ◽  
Supportive Care ◽  
Induction Chemotherapy ◽  
Independent Study ◽  
Recent Analysis ◽  
Study Cohort ◽  
Increased Risk ◽  
Icu Transfer ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Background: Despite improvements in supportive care, treatment of AML remains associated with complications. We have developed a multivariate model – the Treatment-Related Mortality (TRM) score – which includes age, performance status, and 6 other covariates to predict 28-day mortality with c-statistic = 0.82 (1.0 = perfect prediction, 0.5 = no prediction) (Walter et al. J Clin Oncol 2011). We investigated associations between TRM score and complications developing during AML treatment. Patients and Methods: 179 adults (median age 53 [range: 18-77] years) with newly diagnosed AML treated at our institution from 2002-2012 with 7 + 3 or similar therapy were included. Documented infections, ICU transfer, and death until the earlier of day 28 or administration of additional chemotherapy were recorded. Patients were categorized by quartiles of TRM score. All outcomes were treated as time-to-event endpoints. The survival probabilities in the absence of infection or ICU transfer were estimated using the Kaplan-Meier method; the 10 patients in the ICU at the start of chemotherapy were excluded from analysis of ICU transfer as an adverse event. Outcomes between TRM scores by quartile were assessed using log-rank test for trend; scores above and below the median were compared using Cox regression. Multivariate models were adjusted for gender, cytogenetic risk, baseline absolute neutrophil count, and year of treatment. Results: The median TRM score was 4.6 (quartiles 2.3 and 10.5). Documented infections occurred in 72 patients (40%), ICU transfer in 14 (8%), and death in 4 (2%) within 28 days of induction. Patients with higher ranges of TRM scores were more likely to develop infections (Ptrend=0.006; Fig 1a) and require ICU transfer (Ptrend=0.003; Fig 1b). In particular, TRM scores above the median were associated with increased risk of infection (P=0.02; Fig 1c) and ICU transfer P=0.0004; Fig 1d). After multivariable adjustment, the risk of documented infection was 1.72 (95% CI: 1.06-2.81)-fold higher for patients with TRM >4.5. Consistent with our recent analysis, baseline grade 4 neutropenia was also independently associated with infection (HR 2.2 [95% CI: 1.38-3.52]) (Buckley et al. Am J Hematol 2014). There was only one ICU transfer, and there were no deaths among the 92 patients with TRM score less than the median. Although supportive care measures have improved in recent years, a high TRM score was still associated with ICU transfer in the subset of patients treated from 2007-2012 (P=0.001). Conclusions: The TRM score is associated not only with death, but also with other early adverse events. A cut-point of 4.5, which will need to be confirmed in an independent study cohort, may separate low- from high-risk patients in terms of susceptibility to infection and likelihood of requiring an ICU transfer. The TRM score may thus improve assessment of the risks of intensive induction chemotherapy and help allocate health care resources. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

Risk-Adapted Dosing of Melphalan for Systemic AL Amyloidosis (AL) Lowers Treatment-Related Mortality: Early Death but Not Post-3 Month Survival Is Linked to Cardiac Involvement.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1156-1156
Author(s):  
Raymond L. Comenzo ◽  
Ping Zhou ◽  
Hani Hassoun ◽  
Tarun Kewalramani ◽  
Virginia Klimek ◽  
...  
Keyword(s):  
Median Survival ◽  
Cardiac Involvement ◽  
Early Death ◽  
Cardiac Patients ◽  
High Dose ◽  
Cell Transplant ◽  
Cardiac Amyloid ◽  
Organ Systems ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Autologous stem cell transplant (SCT) with high-dose melphalan is a standard therapy for selected patients with AL. Treatment-related mortality (TRM), however, remains 10% to 15%. Risk-adapted melphalan (MEL) aims to reduce TRM (Blood2002;99). Over the past 6 years we have used risk-adapted MEL at 200, 140 and 100 mg/m2. Dosing was based on age (MEL200 if ≤ 60, MEL140 if 61 to 71, MEL100 if > 71) for patients with no cardiac involvement, involvement of 1 or 2 major organ systems (of kidneys, liver/GI tract and peripheral nervous system) and creatinine clearance (CrCl) ≥ 51ml/min. Similarly, with cardiac involvement and/or CrCl < 51, MEL140 was used for those < 61 and MEL100 for those 61 to 71. Patients < 41 were treated with MEL200 as a rule. Patients with advanced involvement of the heart or ≥3 organ systems, or with cardiac involvement and age ≥ 71, were not SCT candidates. We followed TRM, defined as death during G-CSF mobilization or within 100 days of SCT, and also asked if survival at 3 months post-SCT was affected by achievement of complete hematologic response (CR) or by clonal Ig VL germline gene use. Of the 303 amyloid patients seen in that period, 94 were mobilized with G-CSF for SCT, 50M/44W with a median age of 57 (range, 32–73) at a median of 3 months from diagnosis (1–43). None had prior SCT and 71% (n=67) were untreated for plasma cell disease, including 45 who entered a clinical study employing adjuvant oral therapy after SCT. Fifty percent had dominant renal amyloid, 28% (n=27) cardiac, and 71% (n=67) single organ involvement. Clonal lambda disease was present in 83% (n=78) and serum free light-chain abnormalities in 95% (57/60). Patients were assigned to MEL200 (n=35), MEL140 (n=42) or MEL100 (n=17). There were 8 early deaths, 4 related to treatment (RTT), 1 in mobilization and 3 in SCT, and 4 related to progression of disease before SCT. All were associated with cardiac amyloid. Seven of the 8 were in the MEL100 group (RTT=3) and 1 was MEL140 (RTT=1). Overall TRM was 4.3% (4/94) with 3 in the MEL100 group. With a median follow-up of 22 months (1–77), survival is 81% and median survival has not been reached. From mobilization, non-cardiac patients had significantly better survival [88% (59/67) vs 63% (17/27), p<0.01] but from 3 months post-SCT they survived no better than those with cardiac amyloid (p=0.29). Median survival for the MEL100 group is 47 months (vs MEL 200, p=0.02) while median survivals for the others are not yet reached. At 3 months post-SCT, CR neither differed by dose [MEL200 34% (11/32), MEL140 29% (11/38), MEL100 50% (5/10)] nor significantly affected survival [CR 93% (25/27) versus non-CR 88% (45/53), p=0.22]. Clonal Ig VL germline donors were identified in 81 cases [common: 6a=23, 2a2=15, 3r=9, DPK1=5] but did not affect survival. In sum, risk-adapted dosing of melphalan has a low TRM. Patients with cardiac involvement are at risk of early death but by 3 months post-SCT their survival is not significantly different than non-cardiac patients. These results highlight the need for new approaches to improve survival of AL cardiac patients during SCT with risk-adapted melphalan.

Treatment Related Mortality of AML Pediatric Patients in a Single Center in Saudi Arabia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4291-4291
Author(s):  
Wasil Jastaniah ◽  
Mohammed Burhan Abrar ◽  
Taha Khattab
Keyword(s):  
Supportive Care ◽  
Pediatric Patients ◽  
Conflicts Of Interest ◽  
Contributing Factors ◽  
Significant Difference ◽  
Medical City ◽  
Lost To Follow Up ◽  
The Impact ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 4291 Despite minimal changes in therapeutic approach, the outcome of acute myeloid leukemia (AML) in pediatric patients has improved significantly in the past two decades. Supportive care measures may have contributed to this success by reducing treatment related mortality (TRM) and thereby improving the overall survival (OS) of patients. Yet their impact on outcome remained unknown and masked under protocol effect. To assess the impact of supportive care measures on outcome, we undertook a retrospective review of all pediatric patients diagnosed with AML between 1986 and 2011and treated in our institution, the Princess Norah Oncology Center, King Abdulaziz Medical City, Jeddah. A total of 87 patients were reviewed. Of these, two patients whose parents refused treatment and one lost to follow-up were excluded. A total of 84 patients were qualified for the study. These patients were treated with two different protocols based on treatment eras. Patients diagnosed between 1986 and 1995 (era 1) were treated following AML-BFM-78 protocol while patients diagnosed between 1996 and 2011 (era 2) were treated following the MRC AML10. The cumulative TRM incidence was 76% in era1 compared to 11.5% in era 2 (P = 0.0001). This resulted in an improved 5-year OS from 10.5% in era 1 to 56% in era 2 (P = 0.007). The protocols used in both eras were different and may have improved OS. Significant difference in TRM however, suggests that other factors contributed to the improved OS. To gain further insight of the contributing factors, patients who received only MRC AML10 protocol (in era2) were partitioned into two sub-eras based on supportive care measures introduced sequentially in our institution as follows: 1996 to 2002 (era 2a) and 2003 to 2011 (era 2b).The cumulative TRM incidence was 48.6% in era 2a and 4.7% in era 2b (P = 0.001). This also resulted in an improved OS from 33.3% in era 2a to 56.2% in era 2b despite using the same protocol (P = 0.007). Our findings highlight the importance of supportive care as a significant factor in outcome of children. Comparing protocols per se masks the importance of supportive care measures in impacting outcome. We suggest devising a standardized scoring system to evaluate center-specific supportive care measures to quantify the impact of supportive care on TRM and survival outcomes while simultaneously allowing us to distinguish the effect of supportive care from that of protocol and other factors such as ethnicity. Disclosures: No relevant conflicts of interest to declare.

Declining Rates of Treatment-Related Mortality in Patients with Newly Diagnosed Acute Myeloid Leukemia (AML) Given “Intensive” Induction Regimens: A Report From the Southwest Oncology Group (SWOG) and MD Anderson Cancer Center (MDA)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 129-129 ◽  
Author(s):  
Megan Othus ◽  
Hagop M. Kantarjian ◽  
Stephen Petersdorf ◽  
Farhad Ravandi ◽  
Jorge E. Cortes ◽  
...  
Keyword(s):  
Supportive Care ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Cancer Center ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Secondary Aml ◽  
Over Time ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 129 Background Recent emphasis has been placed on administration of induction regimens less intense than standard 3+7 for patients with newly diagnosed AML. A primary goal is to reduce the presumed average treatment related mortality (TRM) rate of 10% occurring within the first 28 days after start of 3+7 or higher intensity therapies; TRM rates have been > 30% in patients who are older and/or have poor performance status (PS]. (Walter et al. JCO 2012). This practice presupposes that TRM rates with higher intensity induction regimens are static, a notion seemingly difficult to reconcile with advances in supportive care (e.g. newer anti-aspergillosis drugs) that have sharply reduced rates of non-relapse mortality after allogeneic hematopoietic cell transplant (Gooley et al. NEJM 2010). Methods We thus addressed rates of TRM from 1991–2009 in 1,409 patients given 3+7 induction regimens on SWOG protocols (cytarabine dose 100 mg/m2 daily × 7) and 1,933 patients given induction regimens containing higher cytarabine doses (at least 1.0 g/m2 daily × 4–5 days) at MDA, variably combined with idarubicin, fludarabine or other agents. Multivariate analyses were used to account for confounding factors. Results TRM rates declined both in SWOG and at MDA. However this reduction must account for the declining ages of patient given 3+7 or more intense induction (p<0.001 in both SWOG and at MDA) and their improved PS (p<0.001 SWOG and MDA);the considerably younger nature of SWOG patients during 2006–2009 reflects the switch to less intense induction regimens for many older patients; such regimens were not included in this analysis. Additionally other covariates associated with TRM (more blood blasts, lower platelets, secondary AML) by Walter et al. (JCO 2012)were unevenly distributed in the various time periods(for example no secondary AML in SWOG 2006–2009). Multivariate logistic regression was thus performed to account for the effect of age, PS, and these other covariates in the reduction in TRM. After such accounting, odds ratios (ORs) for TRM at MDA were (relative to 1995) 0.89, 0.7, and 0.36 for 1996–2000,2001–2005, and 2006–2009 respectively with the null hypothesis of no change over time rejected at p = 0.006. For SWOG, not including secondary AML as a covariate ORs were (relative to 1991– 1995) 0.75,0.78, and 0.42 for 1996–2000,2001–2005,and 2006–2009 respectively; again the hypothesis of no change with time was rejected (p = 0.037). There were no interactions between reduced TRM and age, WBC or performance status suggesting the reduction in TRM was a general phenomenon. Conclusion There has been a reduction over time in TRM after “intensive” induction possibly due to better supportive care. Although various selection biases cannot be excluded, this decline is not due to younger age or better performance status and needs to be considered when choosing AML induction therapy. Disclosures: No relevant conflicts of interest to declare.

Minimal toxicity and mortality in high-risk breast cancer patients receiving high-dose cyclophosphamide, thiotepa, and carboplatin plus autologous marrow/stem-cell transplantation and comprehensive supportive care.

1996 ◽  
Vol 14 (4) ◽  
pp. 1156-1164 ◽  
Author(s):  
H K Holland ◽  
S P Dix ◽  
R B Geller ◽  
S M Devine ◽  
L T Heffner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Metastatic Breast Cancer ◽  
Supportive Care ◽  
Metastatic Breast ◽  
High Dose ◽  
Care Approach ◽  
Risk Breast Cancer ◽  
Treatment Related Mortality ◽  
Related Mortality

PURPOSE To assess the clinical toxicity and outcome associated with a comprehensive supportive care approach in poor-risk breast cancer (BrCA) patients with high-dose chemotherapy (HDC). PATIENTS AND METHODS One hundred twenty-five consecutive patients with stages II, III or metastatic breast cancer received HDC between February 1992 and June 1994. Recipients received 4 days of continuous infusion of cyclophosphamide 1.5 g/m2/d, thiotepa 125 mg/m2/d, and carboplatin 200 mg/m2/d followed by infusion of bone marrow or peripheral-blood stem cells (PBSC) and recombinant human growth factor (rhu-GF) support. Patients received similar supportive care that included administration of prophylactic antibiotics, management of neutropenic fevers, and transfusion support. RESULTS There were 38 women with stage II or III (27 patients with > or = 10 lymph nodes), four with stage IIIB, and 83 with metastatic breast cancer. The median age was 44 years (range, 27 to 61). Grade II or greater nonhematologic toxicities included diarrhea (66%), stomatitis (33%), hepatic venoocclusive disease (VOD) (5%), and pulmonary toxicity (4%). Myeloid and platelet engraftment was comparable between bone marrow and PBSC recipients (P > .1). Infectious complications were rare and consisted of gram-negative bacteremia (1.6%), gram-positive bacteremia (1.6%), fungemia (1.6%), and documented or suspected aspergillosis infection (3%). There was one treatment-related death secondary to severe VOD. CONCLUSION A comprehensive supportive care approach was associated with a low treatment-related mortality rate of less than 1%. With the observed reduction in treatment-related mortality, it is reasonable to evaluate the efficacy of HDC in women with less than 10 positive nodes and stage II disease in well-designed clinical trials.

Classification of treatment-related mortality in children with cancer: a systematic assessment

2015 ◽  
Vol 16 (16) ◽  
pp. e604-e610 ◽  
Author(s):  
Sarah Alexander ◽  
Jason D Pole ◽  
Paul Gibson ◽  
Michelle Lee ◽  
Tanya Hesser ◽  
...  
Keyword(s):  
Children With Cancer ◽  
Systematic Assessment ◽  
Treatment Related Mortality ◽  
Related Mortality

Outpatient Busulfan (BU)/Cytoxan (CY)/VP-16 and Autologous Stem Cell Transplant (ASCT) for Non-Hodgkin’s Lymphoma (NHL) and Hodgkin’s Disease (HD): Comprehensive Supportive Care Program Associated with Low Treatment Related Mortality and Hospital Utilization.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1908-1908
Author(s):  
Scott R. Solomon ◽  
Karen Manion ◽  
Kathy McNatt ◽  
Lawrence E. Morris ◽  
Asad Bashey ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Supportive Care ◽  
Conditioning Regimen ◽  
Low Risk ◽  
Hospital Utilization ◽  
Cell Transplant ◽  
Intermediate Risk ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Busulfan based ASCT protocols are effective therapy for patients (pt.s) with poor risk NHL and HD. This therapy historically required pt.s to be hospitalized to manage treatment related toxicities until neutrophil engraftment with a median stay in most institutions of 21 days. We have developed a comprehensive outpatient approach for the management of pt.s undergoing ASCT. While potential benefits include decreased hospital utilization and increased patient satisfaction, there is paucity of data regarding its feasibility and safety. We report on treatment related mortality (TRM) and outcome results using a comprehensive outpatient care approach in 169 consecutive patients with NHL and HD transplanted at a single institution between February 1998 and December 2006. Excluding the planned admission for stem cell infusion on Day 0, all other aspects of their management (chemotherapy, supportive care) were to be performed in the outpatient facility. Exceptions to this model occurred for pt.s with circumstances that might compromise the safety of the outpatient management, otherwise this was standard practice. Pt.s were seen daily in the clinic during the first 30 days, unless they were hospitalized. The most common reasons for admission included the development of neutropenic fever or mucositis. One hundred sixty-nine consecutive pt.s with a median age of 54 yr.s (22–73) underwent ASCT for NHL (57 diffuse B-cell large cell (DLC), 53 HD, 17 Mantle Cell (MC), 24 Follicular NHL (FL), 6 ALCL, 3 Burkitts, and 9 other subtypes). The conditioning regimen consisted of dose targeted oral BU (1 mg/kg every 6 hours) on days -8 thru -5, CY 60 mg/kg on days -3 and -2 and VP-16 10 mg/kg days -4, -3 and -2. Autologous peripheral blood stem cells were used for 151 pt.s, bone marrow for 8 pt.s and 10 pt.s received both cell sources. The median CD34+ cell dose was 4.9 × 106/kg. Median time to neutrophil and platelet engraftment was 11 (range 9–34) and 17 (range 0–85) days, respectively. There were no (0%) treatment related deaths in the 169 pt.s during either the first 100 days or 1 year post-transplant. Eight high risk patients (3 DLC, 2 ALCL, 1 Burkitts NHL, 1 HD and 1 FL) died of progressive disease by day 100 (days 52 - 85). Stratifying for disease risk per the CIBMTR criteria, the 3-year Kaplan-Meier overall survival (OS) and progressive-free survival (PFS) for pt.s with DLC NHL in all pt.s (n=57), intermediate risk pt.s (n=24) and low risk pt.s (CR1, n= 9) is 67%, 86% and 100%; and 46%; 60% and 100%, respectively. The 3-year OS and PFS for pt.s with HD with low/intermediate risk (n=24) and high risk (n=29) is 78% and 72%; and 51% and 45%, respectively. The 3-year OS and PFS for patients with MC NHL (low risk n=9, intermediate risk n=6) is 68% and 65%, respectively. The 3-year OS for pt.s with FL is 75%. In summary, outpatient ASCT with expectant inpatient management for treatment related toxicities can be conducted safely in the setting of a comprehensive outpatient treatment program with treatment related mortality outcomes that is at least as comparable, if not superior, to those reported in the literature for conventional inpatient ASCT for similar patient cohorts.

scholarly journals Validation of a classification system for treatment-related mortality in children with cancer

2017 ◽  
Vol 1 (1) ◽  
pp. e000082 ◽  
Author(s):  
Hadeel Hassan ◽  
Menie Rompola ◽  
Adam Woolf Glaser ◽  
Sally Elizabeth Kinsey ◽  
Robert Stephen Phillips
Keyword(s):  
Classification System ◽  
Children With Cancer ◽  
Treatment Related Mortality ◽  
Related Mortality

scholarly journals Evaluation of Mortality during Treatement of Acute Myeloid Leukemia in Patients According to Morocco National AML-MA-2011 Protocol in Casablanca

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5177-5177
Author(s):  
Romaric Massi ◽  
Mouna Lamchahab ◽  
Bienvenu Houssou ◽  
Nisrine Khoubila ◽  
Siham Cherkoui ◽  
...  
Keyword(s):  
Health Care ◽  
Supportive Care ◽  
Health Care Providers ◽  
Death Rate ◽  
Myeloid Leukemia ◽  
Early Death ◽  
Care Providers ◽  
Persistent Fever ◽  
Related Mortality ◽  
Acute Myeloid

Abstract Introduction : The treatment of Acute Myeloid Leukemia (AML), in developing countries is characterized by high rate of death during induction cycles. In 2011, the Morocco National AML-MA-2011 Protocol was initiated to treat AML patients according to international standards and was focused on the improvement of supportive care with particular the prevention and management of infection, transfusion support, and, the hand hygiene education of patients, families, and health care providers. One of the objectives of the new protocol was to reduce the induction mortality rate to 10%. This report evaluates the etiology of mortality during AML treatement from 2011 to 2015 in Casablanca Hematology Departement and the impact of improvement of supportive care on the outcome of AML patients. Patients and methods : Were reviewed the data ofpatients (aged 18-60yrs) treated according to AML-MA-2011 protocol from 1st january 2011 to 31th december 2015. Patients with APL or secondary AML were excluded. In 2011 and 2012 patients were hospitalized in conventional rooms without any precautions. At the begining of 2013 to 2015 patients were hospitalized in protected unit, in single rooms with filtered and controlled air. Access to the protected unit is only reserved for medical staff with strict isolation precautions. A group of specialists in hospital hygien and microbiology was established to control, to conduct periodic evaluations, and publish new recommendations hand for washing and hygien. This group also educated patients families and health care providers. Platelet support was provided in the case of bleeding, or whenever the platelet count was less than 10 × 109/L. For infections, Ceftazidime was the first line of antibiotic used. Amikacin was added for persistent fever beyomd 48-h or clinical deterioration. Imipenem was used for persistent fever. Additional antibiotic or antifungal or antiviral was dictated by clinical and biological findings. The Early Death (ED) was defined as death within the first 6 weeks (42 days) of treatment. Early Death was subdivided into two types : ED1 death within the first 15 days of induction 1 and reflects lethal envents due to leukastasis and bleeding. ED2 death within in the period between days 16 and 42 of induction I and reflects deaths caused by complications from infections and bleeding during aplasia after induction I therapy. The treatement-related mortality (TRM) was evaluated based on all patients with complete remission who died after day 28. The analysis of data was done by SPSS 18.0 Résultats : In all323 patients with de novo AML treated betwen 2011-2015, there were 115 (35.60%) deaths. In death group median age was 41 (18-60years) ; sex ratio H/F was 1.16 ; median hemoglobin was 7.38 g/dl (3.1-14.9) ; median platelet was 63.42 G/L (2.25-165) ; median leucocyte was 39.02 G/L (0.97-245) ; 33(28.69%) had hyperleukocytosis ≥50G/L ; for cytology, according to FAB the dominants types was M1 : 42 (36.5%), M2 : 30 (26.08%) , M4 : 17(14.78%) ; according to karyotype 13 (11.3%) had good prognosis ; 86(74.77%) was in intermediate group, 16(13.91%) had adverse prognosis. The death rate after two inductions was 30.34% and the treatement-related mortality was 17.39%.The death rate wich was 27 / year during 2011-2013 decreased to 17 / year between 2014-2015. The analysis of differents deaths is summarized in the table. Conclusion : Comparing the two periodsthe treatement-related mortality decreased but could be reduced by continue hygien education and improvement of supportive care therapy. Disclosures No relevant conflicts of interest to declare.

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