title: Prognostic factors and outcome of recurrence in childhood acute myeloid leukemia.
abstract: BACKGROUND
  Outcome after recurrence of childhood acute myeloid leukemia (AML) is poor. We performed this study to identify prognostic factors for recurrence and for survival after recurrence of AML.
  
  
  METHODS
  The clinical characteristics, biological features, treatment modalities, and outcomes of children with de novo AML who were enrolled on 3 consecutive clinical protocols from 1987 to 2002 at St. Jude Children's Research Hospital were studied. Regression modeling was used to identify prognostic factors for recurrence and for survival after recurrence.
  
  
  RESULTS
  The outcome after recurrence was poor, with a 5-year survival estimate of only 23.3% +/- 5.7%. Multivariable analysis indicated that male sex (P = .005), autologous stem cell transplant before recurrence (P = .097), each additional month from diagnosis to recurrence (P = .041), and stem cell transplant after recurrence (P < .001) were associated with a better survival after recurrence, whereas M5 or M7 morphology (P = .001) were significantly predictive of a lower survival estimate after recurrence.
  
  
  CONCLUSIONS
  Survival after recurrence was poor in children with AML. Novel therapies are urgently needed to prevent or to treat recurring AML.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. jeffrey.rubnitz@stjude.org
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Razzouk
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Stanley
authors.initials: S
authors.lastname: Pounds
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000401:mortality* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012737:Sex Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous