Improved outcome after relapse in children with acute myeloid leukaemia

Abstract

Summary In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event‐free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty‐six percentage achieved remission with survival after relapse (5 years) 34 ± 4%. Of 122 patients who received re‐induction therapy, 77% entered remission with 40 ± 5% survival. Remission rates were similar for different re‐induction regimens but fludarabine, cytarabine, granulocyte colony‐stimulating factor‐based therapy had low treatment‐related mortality. Prognostic factors for survival were duration of first complete remission (CR1) and stem cell transplantation (SCT) in CR1. In early relapse (<1 year in CR1), survival was 21 ± 5% compared with 48 ± 6% in late relapse. For children receiving re‐induction therapy, survival in early relapse was 29 ± 6% and 51 ± 6% in late. Patients treated in CR1 with SCT, autologous SCT or chemotherapy had a survival of 18 ± 9, 5 ± 5 and 41 ± 5%, respectively. Survival was 62 ± 6% in 64 children given SCT as part of their relapse therapy. A significant proportion of children with relapsed AML can be cured, even those with early relapse. Children who receive re‐induction therapy, enter remission and proceed to SCT can achieve a cure rate of 60%.

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

“…Comparable observations have been reported by other groups: A 3-year OS rate of 24% after relapse was reported for treated and untreated pediatric patients from the MRC (Medical Research Council) AML10 trial. 6 The 5-year OS was 34% in 146 patients from the NOPHO (Nordic Society for Pediatric Hematology and Oncology) studies 9 and 33% in 106 patients treated within the French LAME (Leucémie Aiguë Myéloblas-tique Enfant) 89/91 protocol. 3 Data from the St Jude institutional trials showed a 5-year OS of 23% in 160 relapse patients.…”

“…4,7,8 Allo-SCT in CR2 has been associated with a 5-year OS rate of 62% in recent studies. 9 From 1987 to 2003, a total of 1251 patients with de novo AML were registered in three consecutive protocols of the AML-Berlin/Frankfurt/Muenster study group (AML-BFM-87, AML-BFM-93, AML-BFM-98), of whom 379 patients relapsed between 1987 and 2007. In this study, we analyze the outcome after relapse in this cohort on the basis of the intensity of firstline treatment, including allo-SCT or autologous SCT (auto-SCT), duration of first remission, modalities of relapse treatment and achievement of a second complete remission (CR2).…”

Outcomes of allogeneic stem cell transplantation among patients with acute myeloid leukemia presenting active disease: Experience of a single European Comprehensive Cancer Center

“…3,5,6 Recent results from clinical trials indicate a 1-year overall survival (OS) rate of 60 to 70%. [7][8][9] In children with AML who relapsed post-ASCT and after a second ASCT, it was reported at approximately 30 to 40% by Lee et al 9 In 2013, survival outcomes were reported to be similar between adolescents and children with AML following ASCT. 10 Myeloablative preparative regimen used for ASCT induces profound neutropenia and platelet decrease.…”

Allo-SCT using BU, CY and melphalan for children with AML in second CR

“…In the case of relapse the prospects of cure remain dismal with alternate chemotherapy. [3][4][5] Data from the most recent international BFM relapse show that only 72% of children achieve a second CR. Five-year OS was 32%.…”