Experience with four consecutive BFM-based protocols for treatment of childhood with non-promyelocytic acute myeloblastic leukemia in Argentina

Abstract

Childhood acute myeloid leukemia (AML) achieves event-free-survival (EFS) rates of ∼50%. Double induction phase has been introduced for improving these results. Four consecutive protocols for AML treatment were evaluated to assess the impact of the addition of a second induction course in our setting. From January 1990 to January 2014, 307 evaluable AML patients were accrued. They were classified into low-risk (LR) and high-risk (HR) according to cytogenetic/molecular findings and response on day 15. The first two studies administered one induction cycle while the latter two protocols administered double induction. Relapse was the most frequent event and early-deaths were reduced by 50% in the last protocol. Statistically significant differences were observed when comparing EFS in LR and HR groups. Patients from both risk-groups who received double induction achieved significantly better outcome. EFS improved in protocols with double induction and early-deaths rate was decreased. Cytogenetic/molecular features and early-response were confirmed as prognostic factors.

Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature

“…CR rates varied from 32% to 100% (n=19 studies), and nine studies described a CR rate of 80% or higher [22,27,28,30,36,39,40,42,45]. CR rates were over 64% in the remaining ten studies, with the exception of two which described CR rates of merely 35% [29,38].…”

“…In all but one of the studies [34], induction courses were based on a two-or three-drug regimen: cytarabine and an anthracycline (i.e., daunorubicin, doxorubicin, idarubicin), or a combination of these two drugs with etoposide. As the second induction course, a few studies administered highdose cytarabine in combination with mitoxantrone [22,28,31,40]. For consolidation courses, the most commonly used chemotherapeutic agent was cytarabine, either administered alone or in combination with an anthracycline or etoposide.…”

“…For consolidation courses, the most commonly used chemotherapeutic agent was cytarabine, either administered alone or in combination with an anthracycline or etoposide. During study periods from nearly twenty years ago, consolidation courses also frequently consisted of the combination of a corticosteroid (either prednisone or dexamethasone) with 6-thioguanine (6-TG) or 6-mercaptopurine (6-MP), vincristine, an anthracycline, and cytarabine, with or without cyclophosphamide [20,23,27,28,38,40,42,44]. Intensification of induction and consolidation courses consisted mainly of intermediate-or high-dose cytarabine, with or without the addition of an anthracycline or etoposide.…”

“…Median follow-up times from diagnosis were reported in ten studies and varied from 0.6 to 13 years [20,-,26-28,31,35,39,42,44,45]. One study reported a mean followup time from diagnosis of 13.5 years [40]. With regard to abandonment, rates varied from 0% to 78% (n=16 studies).…”

Knockdown of WAVE1 enhances apoptosis of leukemia cells by downregulating autophagy

“…The clinical outcomes of pediatric AML have improved significantly over the past few decades so that the long-term survival rate stands at ~70%. Improvement is due to intensification of chemotherapeutic regimens, optimal riskgroup stratification, timely salvage for relapse and enhanced supportive cares (1)(2)(3). Despite intensive treatment, ~30% of pediatric patients relapsed with poor outcomes.…”