Acute Myeloid Leukemia Coverage From Every Angle

Relapsed AML in Children and Hematopoietic Cell Transplantation

By: Hillary Ojeda
Posted: Wednesday, November 25, 2020

For children with acute myeloid leukemia (AML) who have a second complete remission (CR2) before hematopoietic cell transplantation (HCT), their prognosis appears to be improved, according to a study conducted by Daisuke Tomizawa, MD, PhD, of the National Center for Child Health and Development, Tokyo, and colleagues. These findings were published in Pediatric Blood & Cancer, and the authors suggest further studies are warranted to create individualized treatment strategies for this patient population.

“These data show a slightly better outcome in comparison to other historical studies,” the authors commented. “One possible reason for this is that 111 relapsed patients in the AML-05R study included a high percentage of patients with relapsed [core-binding factor] AML due to excessive treatment reduction in the AML-05 study.”

In the Japanese Pediatric Leukemia/Lymphoma Study Group AML‐05R study, 443 patients with AML up to age 18 were enrolled between 2006 and 2010. Of the total, 137 patients relapsed, and 43 had primary induction failure. The authors retrospectively analyzed the patients using questionnaires distributed in 2012 and 2013. A total of 93 leukemic samples of bone marrow were collected at diagnosis of 111 patients. The authors then analyzed the 111 patients and determined the 5-year overall survival rate was 36.1%.

The mean duration in the nonsurviving group was 10.1 ± 4.1 months, whereas it was 16.3 ± 8.3 months in the surviving group. Etoposide, cytarabine, and mitoxantrone (ECM)‐ or fludarabine, cytarabine, and granulocyte colony‐stimulating factor (FLAG)‐based regimens were suggested for reinduction therapy. “A genetic analysis also revealed the prognostic significance of FMS‐like tyrosine kinase 3 (FLT3)‐internal tandem duplication as a poor prognostic marker (P = .04) and core binding factor AML, t(8;21), and inv(16) as good prognostic markers (P < .01),” the authors concluded.

Disclosure: The study authors reported no conflicts of interest.

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