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Variation in Care and Outcomes in Pediatric Acute Leukemia

Children’s Hospital of Philadelphia
Amanda DiNofia, MD
Grant Type: 
Young Investigator Grants
Year Awarded: 
Type of Childhood Cancer: 
Acute Lymphoblastic Leukemia (ALL)
Project Description: 


Leukemia is cancer of white blood cells. There are different types of leukemia, but the two broad categories are acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Treatment for leukemia varies according to the subtype, but the first month of treatment for all leukemia is called induction. Patients have a 1-2% risk of death during this period, but there is variability in this rate when deaths are compared among U.S. pediatric hospitals using information from a billing database, called the Pediatric Health Information System (PHIS). Rates in this database varied from 0 to 3.7% in ALL and 0 to 14.8% in AML.

Project Goal

Since deaths during induction for pediatric leukemia vary across pediatric hospitals, there are likely characteristics associated with the hospital that influence this outcome. The goal of this study is to identify hospital features and treatment patterns that occur in these hospitals with high mortality rates.  Billing data for individual patients in PHIS can be combined with information from the American Hospital Association (AHA) database that contains detailed information about the hospitals where individual patients are admitted. AHA data will provide the hospital characteristics and PHIS data will provide the treatment patterns that are linked to induction deaths. Patients will also be interviewed to understand their perspective on their induction care. Results from this study could lead to a decrease in the number of childhood deaths during induction and establish a standard of induction care that is safe and modeled on patient preferences.

"The pediatric oncology community has celebrated great improvements in survival for patients diagnosed with acute leukemia over the past several decades.  With the support of the Alex's Lemonade Stand Foundation Young Investigator (ALSF YIA) grant, I plan to uncover why a large percentage of patients with leukemia are still not able to be cured of their disease." - Amanda DiNofia, MD