title: Toxicity and outcome of children with treatment related acute myeloid leukemia.
abstract: BACKGROUND
  The aim of this study was to evaluate the clinical course and outcome of children with treatment related acute myeloid leukemia (tAML) and compare them to children with primary AML (pAML).
  
  
  METHODS
  We retrospectively reviewed the demographic, treatment, toxicity, and outcome data of children with tAML and treatment related myelodysplastic syndrome (tMDS), treated at our institution between 1975 and 2005. We compared these parameters with matched controlled children with pAML. Finally we compared overall survival (OS) for tAML with all pAML children treated at the study era in our institution.
  
  
  RESULTS
  Twenty-one patients with tAML (n = 19) and tMDS (n = 2) were identified. Three years event-free survival (EFS) and OS were both 14 +/- 8%. Compared to pAML patients, tAML had a higher rate of adverse cytogenetics (P < 0.008) and inferior OS (P = 0.027) but no significant difference in treatment toxicity or death. All survivors were treated with allogeneic hematopoietic stem cell transplantation (HSCT).
  
  
  CONCLUSIONS
  In this population based report of pediatric tAML, outcome was poor and was related to a higher probability of poor cytogenetic features rather than excessive toxicities or inability to deliver therapy. HSCT should be considered for patients with tAML. These preliminary findings should set the stage for prospective cooperative studies.
authors.affiliation: Departments of Hematology Oncology and Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Uri
authors.initials: U
authors.lastname: Tabori
authors.forename: Giselle
authors.initials: G
authors.lastname: Revach
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: Brigitte
authors.initials: B
authors.lastname: Strahm
authors.forename: Alisa
authors.initials: A
authors.lastname: Rachlis
authors.forename: Mary
authors.initials: M
authors.lastname: Shago
authors.forename: Ronald
authors.initials: R
authors.lastname: Grant
authors.forename: John
authors.initials: J
authors.lastname: Doyle
authors.forename: David
authors.initials: D
authors.lastname: Malkin
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000139:chemically induced / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate