Prognostic factors and outcome of recurrence in childhood acute myeloid leukemia

Abstract

Dixon imaging techniques derive chemical shift‐separated water and fat images, enabling the quantification of fat content and forming an alternative to fat suppression. Whole‐body Dixon imaging is of interest in studies of obesity and the metabolic syndrome, and possibly in oncology. A three‐point Dixon method is proposed where two solutions are found analytically in each voxel. The true solution is identified by a multiseed three‐dimensional region‐growing scheme with a dynamic path, allowing confident regions to be solved before unconfident regions, such as background noise. 2π‐Phase unwrapping is not required. Whole‐body datasets (256 × 184 × 252 voxels) were collected from 39 subjects (body mass index 19.8‐45.4 kg/m2), in a mean scan time of 5 min 15 sec. Water and fat images were reconstructed offline, using the proposed method and two reference methods. The resulting images were subjectively graded on a four‐grade scale by two radiologists, blinded to the method used. The proposed method was found superior to the reference methods. It exclusively received the two highest grades, implying that only mild reconstruction failures were found. The computation time for a whole‐body dataset was 1 min 51.5 sec ± 3.0 sec. It was concluded that whole‐body water and fat imaging is feasible even for obese subjects, using the proposed method. Magn Reson Med 63:1659–1668, 2010. © 2010 Wiley‐Liss, Inc.

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

“…3 Data from the St Jude institutional trials showed a 5-year OS of 23% in 160 relapse patients. 4 Within the AML-BFM study periods (Figure 1), CR and survival rates after first relapse improved despite the intensification of first-line induction therapy. This improvement could not be related to the type or the intensity of relapse chemotherapy, which might result from the heterogeneity of relapse treatment and the low numbers of patients treated according to the different regimens.…”

“…5 French-American-British (FAB) subtypes as well as cytogenetics and intensity of first-line treatment including allogeneic stem cell transplantation (allo-SCT) are well recognized as additional prognostic factors in the relapse setting. 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).…”

“…Survival after recurrence was poor so far, ranging from 21 to 33%. [3][4][5][6] The duration of first complete remission (CR1) has been reported to be the major prognostic factor in relapse with a 5-year survival of only 10% in early relapse defined as relapse occurring within 12 months after diagnosis. 5 French-American-British (FAB) subtypes as well as cytogenetics and intensity of first-line treatment including allogeneic stem cell transplantation (allo-SCT) are well recognized as additional prognostic factors in the relapse setting.…”

Successful outcome of allo-SCT in high-risk pediatric AML using chemotherapy-only conditioning and post transplant immunotherapy

“…4,24 The median age of our series of children was just over 2 years. It could be argued that young age may have influenced the good outcome in our patient group, although very recent data from CIBMTR have suggested an increased risk of relapse in children under 5 years of age (Davies SM, personal communication).…”

“…However, those that relapse within 1 year from the time of diagnosis have a poorer prognosis. 3,4 Children who are refractory to de novo or salvage chemotherapy have a dismal prognosis with less than 20% of children being salvaged by SCT. 5 A poor prognosis has also been associated with secondary AML: 15% at 3 years.…”