Risk-stratified therapy and the intensive use of cytarabine improves the outcome in childhood acute myeloid leukemia: The AML99 trial from the Japanese childhood AML cooperative study group

Ichiro Tsukimoto, Akio Tawa, Keizo Horibe, Ken Tabuchi, Hisato Kigasawa, Masahiro Tsuchida, Hiromasa Yabe, Hideki Nakayama, Kazuko Kudo, Ryoji Kobayashi, Kazuko Hamamoto, Masue Imaizumi, Akira Morimoto, Shigeru Tsuchiya, Ryoji Hanada

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Abstract

Purpose: To improve the prognosis in children with newly diagnosed acute myeloid leukemia (AML) by introducing a dose-dense intensive chemotherapy regimen and an appropriate risk stratification system. Patients and Methods: Two hundred forty children with de novo AML were treated with continuous cytarabine-based induction therapy and stratified to three risk groups based on the initial treatment response, age, and WBC at diagnosis and cytogenetics. All of the patients were treated with intensive consolidation chemotherapy including three or four courses of high-dose cytarabine. Allogeneic hematopoietic stem-cell transplantation (HSCT) was indicated for only the intermediate-risk patients with matched related donors and for all the high-risk subsets. Results: Two hundred twenty-seven children (94.6%) achieved a complete remission (CR). Four children demonstrated induction death. The median follow-up of the live patients was 55 months (range, 37 to 73 months). The 5-year overall survival of all 240 children was 75.6% (95% CI, 70.3% to 81.4%) and event-free survival was 61.6% (95% CI, 55.8% to 68.1%). The 5-year disease-free survival in each risk group were 71.3% (95% CI, 63.4% to 80.2%) in the low-risk group (n = 112), 59.8% (95% CI, 50.6% to 70.7%) in the intermediate-risk group (n = 92), and 56.5% (95% CI, 39.5% to 80.9%) in the high-risk group (n = 23). Eight children died during the first CR, including four after HSCT. Conclusion: A high survival rate, 75.6% at 5 years, was achieved for childhood with de novo AML in the AML99 trial. The treatment strategy was well tolerated with only 1.7% induction death rate and 3.5% remission death rate. Low-risk children were successfully treated with chemotherapy alone.

Original languageEnglish
Pages (from-to)4007-4013
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number24
DOIs
Publication statusPublished - 20-08-2009

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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    Tsukimoto, I., Tawa, A., Horibe, K., Tabuchi, K., Kigasawa, H., Tsuchida, M., Yabe, H., Nakayama, H., Kudo, K., Kobayashi, R., Hamamoto, K., Imaizumi, M., Morimoto, A., Tsuchiya, S., & Hanada, R. (2009). Risk-stratified therapy and the intensive use of cytarabine improves the outcome in childhood acute myeloid leukemia: The AML99 trial from the Japanese childhood AML cooperative study group. Journal of Clinical Oncology, 27(24), 4007-4013. https://doi.org/10.1200/JCO.2008.18.7948