Treatment and long-term results in children with acute myeloid leukaemia treated according to the AIEOP AML protocols.
Since 1982, four consecutive studies on childhood acute myeloid leukaemia (AML) (namely LAM-82, -87, -87M and -92) have been conducted in Italy by the Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP) group. The induction therapy of the first three studies consisted of daunorubicin and cytarabine structured in a 3+7 backbone. In the most recent protocol (LAM92), patients received two induction courses including idarubicin, cytarabine and etoposide. Patients with acute promyelocytic leukaemia (20% of diagnoses) were included in LAM-87 and 87M studies. Postremissional therapy significantly changed over time, with an ever-increasing role given to stem cell transplantation (SCT). The long-term outcome of patients enrolled in the LAM-82, 87 and 87M studies was comparable, whereas that of children treated according to LAM-92 study was significantly better (P<0.005). Either allogeneic or autologous SCT was employed as consolidation therapy in more than 75% of cases enrolled in this latter study. Patients enrolled in the LAM-92 study were stratified in standard and high-risk groups with different outcome (67 vs 47%, respectively, P=0.04). Altogether, the results obtained in these four studies have permitted a progressive refinement of treatment, contributing to the structure of the ongoing LAM-2002 protocol that stratifies patients according to the presence of definite genetic anomalies and response to induction therapy.
Pession
A
A
Clinica Pediatrica, Università di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. andrea.pession@unibo.it
Rondelli
R
R
Basso
G
G
Rizzari
C
C
Testi
A M
AM
Fagioli
F
F
De Stefano
P
P
Locatelli
F
F
D000208:Acute Disease; D000293:Adolescent; D024221:Antineoplastic Protocols / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000401:mortality / Q000628:therapy*; D008297:Male; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome