Definition of a standard‐risk group in children with AML

Abstract

Summary.To define paediatric AML patients with a favourable outcome in order to design a risk-adapted therapy, we analysed 489 children under 17 years of age treated similarly in studies AML-BFM 83 and 87. 369 patients (75·4%) achieved remission. Estimated probabilities of survival, event-free survival (EFS) and disease-free survival (DFS) at 5 years were 50% (SE 2%), 43% (SE 2%) and 58% (SE 3%), respectively. Multivariate analysis revealed bone marrow blasts on day 15, morphologically defined risk groups and hyperleucocytosis to be of prognostic value. EFS at 5 years estimated for patients with р5% and >5% blasts on day 15 were 56% (SE 3%) v 27% (SE 4%); for the favourable morphological subgroups (M1/M2 with Auer rods, M3 and M4eo) it was 60% (SE 4%) compared with other patients (33%, SE 3%), P (Kaplan-Meier) ¼ 0·0001 each. Hyperleucocytosis proved to be an independent prognostic factor, indicating a high risk, especially for early failure. The specific karyotypes t(8;21), t(15;17) and inv16 were closely related to the favourable morphology and outcome was in the same range. We conclude that for the definition of a standard-risk group a combination of morphological and response criteria may be sufficient. The standard-risk group defined by favourable morphology and a blast cell reduction on day 15 (not required for M3) comprises 31% of all patients, P survival, pEFS and pDFS at 5 years were 73% (SE 4%), 68% (SE 5%) and 76% (SE 4%), respectively.

Prognostic variables in newly diagnosed children and adolescents with acute myeloid leukemia: Children's Cancer Group Study 213

“…In these classification systems, patients are assigned to good, standard, and/or poor risk categories based upon a combination of age, sex, initial white blood count, FAB classification, early response (usually day 14-15 marrow status) and cytogenetics. [25][26][27] The data in this report support some of the criteria used in these systems (early response, WBC, some FAB criteria and abnormal 16) and offers others (hepatomegaly, platelet count) for inclusion. It also raises concern about the inclusion of some other criteria in an overall favorable prognostic grouping.…”

Favorable outcome in infants with AML after intensive first- and second-line treatment: an AML-BFM study group report

“…25 Acute toxicities in infants, apparent by the early death rate, were unacceptably high in the past (15% in patients o2 years in studies AML-BFM-83/87) 26 and remained slightly higher than in older patients; however, considering the high percentage of infants with hyperleukocytosis, there was no difference in the older age group. 26 Compared to older children acute toxicities in infants during induction chemotherapy were higher, concerning severe infections and pulmonary toxicities (earlier and more frequent respiratory support was necessary, probably due to a higher pulmonary susceptibility and less tolerance to compensate ventilation problems in infants). 27 This also indicates that close monitoring of the pulmonary condition is required.…”

Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials

“…Overall, 27% of all patients with relapse had been stratified to the standard-risk and 73% to the high-risk group at initial treatment according to morphology and early treatment response at day 15. 17 Most of the relapsed patients were treated with chemotherapy only in CR1 (n ¼ 336, 88%), 43 patients (11%) were transplanted in CR1 (n ¼ 36, (9%) with allo-SCT; n ¼ 7, (2%) patients with auto-SCT).…”