Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol

Hideki Nakayama, Ken Tabuchi, Akio Tawa, Ichiro Tsukimoto, Masahiro Tsuchida, Akira Morimoto, Hiromasa Yabe, Keizo Horibe, Ryoji Hanada, Masue Imaizumi, Yasuhide Hayashi, Kazuko Hamamoto, Ryoji Kobayashi, Kazuko Kudo, Akira Shimada, Takako Miyamura, Hiroshi Moritake, Daisuke Tomizawa, Takashi Taga, Souichi Adachi

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13 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)171-179
Number of pages9
JournalInternational journal of hematology
Volume100
Issue number2
DOIs
Publication statusPublished - Aug 2014

Keywords

  • Acute myeloid leukemia (AML)
  • Children
  • Hematopoietic stem cell transplantation (HSCT)
  • Relapse
  • Second complete remission (CR2)

ASJC Scopus subject areas

  • Hematology

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    Nakayama, H., Tabuchi, K., Tawa, A., Tsukimoto, I., Tsuchida, M., Morimoto, A., Yabe, H., Horibe, K., Hanada, R., Imaizumi, M., Hayashi, Y., Hamamoto, K., Kobayashi, R., Kudo, K., Shimada, A., Miyamura, T., Moritake, H., Tomizawa, D., Taga, T., & Adachi, S. (2014). Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol. International journal of hematology, 100(2), 171-179. https://doi.org/10.1007/s12185-014-1616-9