TY - JOUR
T1 - Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol
AU - Nakayama, Hideki
AU - Tabuchi, Ken
AU - Tawa, Akio
AU - Tsukimoto, Ichiro
AU - Tsuchida, Masahiro
AU - Morimoto, Akira
AU - Yabe, Hiromasa
AU - Horibe, Keizo
AU - Hanada, Ryoji
AU - Imaizumi, Masue
AU - Hayashi, Yasuhide
AU - Hamamoto, Kazuko
AU - Kobayashi, Ryoji
AU - Kudo, Kazuko
AU - Shimada, Akira
AU - Miyamura, Takako
AU - Moritake, Hiroshi
AU - Tomizawa, Daisuke
AU - Taga, Takashi
AU - Adachi, Souichi
N1 - Funding Information:
Acknowledgments The authors deeply appreciate the invaluable cooperation by the large number of physicians working at institutions affiliated to The Japanese Childhood AML Cooperative Study Group and The Japanese Pediatric Leukemia/Lymphoma Study Group. Research was supported by Grant-in-Aid for Cancer Research from the Ministry of Health, Labor, and Welfare of Japan.
PY - 2014/8
Y1 - 2014/8
N2 - The outcomes of children with relapsed acute myeloid leukemia (AML) are known to be poor, but remain obscure. We retrospectively analyzed 71 patients who had relapsed following first-line treatment under the AML99 protocol. We investigated the time and site of recurrence, response to re-induction therapy, and performance of hematopoietic stem cell transplantation (HSCT) in relapsed cases, and performed a multivariate analysis to identify prognostic factors. The 5-year overall-survival (OS) rate after relapse was 37 %. Of 71 patients, three died without any anti-leukemic therapy and two underwent allogeneic HSCT. The remaining 66 patients received re-induction chemotherapy, and 33 (50 %) achieved second CR (CR2). Twenty-two of 25 (88 %) late relapse patients and 11 of 41 (27 %) early relapse patients achieved CR2 (P < 0.001). Twenty-nine CR2 cases and 35 non-CR2 cases underwent allogeneic HSCT. The 5-year OS rate was significantly higher in patients who underwent HSCT in CR2 than those in non-CR2 (66 vs. 17 %, P < 0.000001). Multivariate analysis indicated that early relapse (P < 0.05) and the positivity of the FMS-like tyrosine kinase 3-internal tandem duplication (P < 0.05) were adverse prognostic factors for survival. In conclusion, the etiology of relapsed pediatric AML needs to be elucidated and effective chemotherapy should be administered to obtain CR2.
AB - The outcomes of children with relapsed acute myeloid leukemia (AML) are known to be poor, but remain obscure. We retrospectively analyzed 71 patients who had relapsed following first-line treatment under the AML99 protocol. We investigated the time and site of recurrence, response to re-induction therapy, and performance of hematopoietic stem cell transplantation (HSCT) in relapsed cases, and performed a multivariate analysis to identify prognostic factors. The 5-year overall-survival (OS) rate after relapse was 37 %. Of 71 patients, three died without any anti-leukemic therapy and two underwent allogeneic HSCT. The remaining 66 patients received re-induction chemotherapy, and 33 (50 %) achieved second CR (CR2). Twenty-two of 25 (88 %) late relapse patients and 11 of 41 (27 %) early relapse patients achieved CR2 (P < 0.001). Twenty-nine CR2 cases and 35 non-CR2 cases underwent allogeneic HSCT. The 5-year OS rate was significantly higher in patients who underwent HSCT in CR2 than those in non-CR2 (66 vs. 17 %, P < 0.000001). Multivariate analysis indicated that early relapse (P < 0.05) and the positivity of the FMS-like tyrosine kinase 3-internal tandem duplication (P < 0.05) were adverse prognostic factors for survival. In conclusion, the etiology of relapsed pediatric AML needs to be elucidated and effective chemotherapy should be administered to obtain CR2.
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U2 - 10.1007/s12185-014-1616-9
DO - 10.1007/s12185-014-1616-9
M3 - Article
C2 - 24961644
AN - SCOPUS:84905901486
SN - 0925-5710
VL - 100
SP - 171
EP - 179
JO - International Journal of Hematology
JF - International Journal of Hematology
IS - 2
ER -