Development of treatment and clinical results in childhood acute myeloid leukemia in Poland

Abstract

BackgroundSince 1983 four consecutive unified regimens: acute myeloid leukemia-Polish pediatric leukemia/lymphoma study group (AML-PPLLSG) 83, AML-PPLLSG 94, AML-PPLLSG 98 and AML-BFM 2004 Interim, for AML have been conducted by the Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG). In this paper, we review four successive studies on the basis of acute myeloid leukemia-Berlin–Frankfurt–Munster (AML-BFM) protocol, in which a stepwise improvement of treatment outcome was observed. Treatment results of the last protocol AML-BFM 2004 Interim are presented in detail.MethodsThree hundred and three patients with de novo AML were treated according to the AML-BFM 2004 Interim at 15 Polish centers from January 1, 2005 to June 30, 2011. A confrontation with previous treatment periods was based upon historical, already published data.ResultsIn four consecutive periods, 723 children were eligible for evaluation (208, 83, 195, and 237, respectively). Complete remission rates in consecutive periods were: 71, 68, 81 and 87 %, respectively. The 5-year overall survival rates, event-free survival rates, and relapse-free survival rates were 33, 32, and 45%, respectively for AML-PPLLSG 83 regimen; 38, 36, and 53 % respectively for AML-PPLLSG 94 regimen; 53, 46, and 65 % respectively for AML-PPLLSG 98 regimen, and 63, 52, and 64 % for AML–BFM Interim 2004, respectively. Incidence of early deaths and that due to complications (mainly infections) in the first remission decreased over time from 22 to 4.6 % and from 10 to 5.9 %, respectively.ConclusionsDespite continuous improvement in the treatment outcome, the number of failures still remains too high. Further progress seemed to be possible due to continued cooperation of oncology centers within large international study groups.

Central nervous system haemorrhage causing early death in acute promyelocytic leukaemia

“…Introduction of ATRA into the clinical practice had a profound effect on disease-free survival; however, the early death rate (defined as death within 30 days of diagnosis) has not changed significantly and still accounts for 17-30% of deaths [ 5 , 7 ]. Treatment of APL in Polish children is based on the AML-BFM2004 INTERIM protocol [ 10 ]. The induction phase consists of a combination of ATRA, cytarabine (intravenous and intrathecal), idarubicin, and etoposide.…”

“…The induction phase consists of a combination of ATRA, cytarabine (intravenous and intrathecal), idarubicin, and etoposide. ATRA should be applied during the whole treatment period [ 10 ]. Combination of chemotherapy and ATRA induces complete remission in 80-95% of patients and improves treatment efficiency [ 8 , 10 – 12 ].…”

“…Haemorrhages result from thrombocytopaenia, disseminated intravascular coagulopathy (DIC), and systemic fibrinolysis [ 7 ]. The diagnosis of APL is based on the identification of promyelocytes with specific morphology, flow cytometry, classical cytogenetics, and molecular testing by fluorescent in situ hybridisation (FISH) [ 10 ].…”

Treatment results for children and adolescents with acute myeloid leukemia in Middle and Eastern European countries

“…In this issue of memo, reports from groups in Poland [14], Czech Republic [15], Hungary [16], Slovakia [17], and Serbia [18] will further introduce the history of the treatment of childhood AML in each country during the last 10-30 years. They show that new diagnostic methods have been introduced and that patients were classified into risk groups.…”

Cure and care for children and adolescents with acute myeloid leukemia in Middle and Eastern European countries: part II

“…Recently, a valuable overview over the past and current standards, treatment results as well as challenges in the management of pediatric AML throughout several European countries including Czech Republic, Hungary, Serbia, Slovak Republic, and Poland was provided in Memo [1][2][3][4][5][6]. In this issue, further three European national pediatric hemato-oncology study groups (from Austria, Greece, and Slovenia) report their data-which were collected over a long observation period of 20 years-in a similar way [7][8][9].…”