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Response-Guided Induction Therapy in Pediatric Acute Myeloid Leukemia With Excellent Remission Rate
Queen Silvia Children’s Hospital, Gothenburg.
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2011 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 29, no 3, 310-315 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course.

Patients and Methods

All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (>= 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine, cytarabine, and granulocyte colony-stimulating factor. Poor responders received allogeneic stem-cell transplantation (SCT) as consolidation.

Results

Seventy-four percent of patients had good response, 17% had intermediate response, and 7% had poor response after the first course. The overall remission frequency was 97.4%, with 92% in remission after the second course. The rate of induction death was 1.3%. Patients with an intermediate response had a lower event-free survival of 35% compared with good (61%) and poor responders (82%).

Conclusion

The NOPHO-AML 2004 induction strategy gives an excellent remission rate with low toxic mortality in an unselected population. Outcome is worse in patients with intermediate response but may be improved by intensifying consolidation in this group using SCT.

Place, publisher, year, edition, pages
2011. Vol. 29, no 3, 310-315 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-142605DOI: 10.1200/JCO.2010.30.6829ISI: 000286319000021PubMedID: 21149663OAI: oai:DiVA.org:uu-142605DiVA: diva2:387741
Note
University Hospital, UppsalaAvailable from: 2011-01-14 Created: 2011-01-14 Last updated: 2017-12-11Bibliographically approved

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