Journal article
Outcome after intensive reinduction therapy and allogeneic stem cell transplant in paediatric relapsed acute myeloid leukaemia
Institution for Clinical Sciences, Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.1
Department of Clinical Sciences, Paediatrics, Umea University, Umea, Sweden.2
Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.3
Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki, Finland.4
Children's Hospital, Landspitali University Hospital, Hringbraut, Reykjavik, Iceland.5
Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.6
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.7
Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada.8
Department of Paediatrics, Oslo University Hospital, Oslo, Norway.9
Given that 30-40% of children with acute myeloid leukaemia (AML) relapse after primary therapy it is important to define prognostic factors and identify optimal therapy. From 1993 to 2012, 543 children from the Nordic countries were treated according to two consecutive protocols: 208 children relapsed.
The influence of disease characteristics, first line treatment, relapse therapy and duration of first remission on outcome was analysed. Second complete remission (CR2) was achieved in 146 (70%) patients. Estimated 5-year overall survival (OS5y ) was 39 ± 4% for the whole group and 43 ± 4% for the 190 patients given re-induction therapy, of whom 76% received regimens that included fludarabine, cytarabine (FLA) ± anthracyclines, 18% received Nordic Society for Paediatric Haematology and Oncology (NOPHO) upfront blocks and 5% received other regimens.
Late relapse ≥1 year from diagnosis, no allogeneic stem cell transplantation (SCT) in first remission and core binding factor AML were independent favourable prognostic factors for survival. For the 128 children (124 in CR2) that received SCT as consolidation therapy after relapse, OS5y was 61 ± 5%.
Four of 19 children (21%) survived without receiving SCT as part of relapse therapy. Our data show that intensive re-induction followed by SCT can give cure rates of 40% in children with relapsed AML.
| Language: | English |
|---|---|
| Year: | 2017 |
| Pages: | 592-602 |
| ISSN: | 13652141 , 09631860 and 00071048 |
| Types: | Journal article |
| DOI: | 10.1111/bjh.14720 |
| ORCIDs: | Karlsson, Lene and Zeller, Bernward |
Adolescent Antineoplastic Combined Chemotherapy Protocols Biomarkers, Tumor Child Child, Preschool Chromosome Aberrations Core Binding Factors Female Follow-Up Studies Humans Infant Infant, Newborn Journal Article Leukemia, Myeloid, Acute Leukemic Infiltration Male Prognosis Recurrence Remission Induction Risk Factors Stem Cell Transplantation Survival Analysis Treatment Outcome acute myeloid leukaemia allogenic stem cell transplant childhood relapsed survival
