title: Improved outcome after relapse in children with acute myeloid leukaemia.
abstract: In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty-six percentage achieved remission with survival after relapse (5 years) 34 +/- 4%. Of 122 patients who received re-induction therapy, 77% entered remission with 40 +/- 5% survival. Remission rates were similar for different re-induction regimens but fludarabine, cytarabine, granulocyte colony-stimulating factor-based therapy had low treatment-related mortality. Prognostic factors for survival were duration of first complete remission (CR1) and stem cell transplantation (SCT) in CR1. In early relapse (<1 year in CR1), survival was 21 +/- 5% compared with 48 +/- 6% in late relapse. For children receiving re-induction therapy, survival in early relapse was 29 +/- 6% and 51 +/- 6% in late. Patients treated in CR1 with SCT, autologous SCT or chemotherapy had a survival of 18 +/- 9, 5 +/- 5 and 41 +/- 5%, respectively. Survival was 62 +/- 6% in 64 children given SCT as part of their relapse therapy. A significant proportion of children with relapsed AML can be cured, even those with early relapse. Children who receive re-induction therapy, enter remission and proceed to SCT can achieve a cure rate of 60%.
authors.affiliation: Department of Clinical Sciences, Queen Silvia's Childrens Hospital, Gothenburg, Sweden. jonas.abrahamsson@vgregion.se
authors.forename: Jonas
authors.initials: J
authors.lastname: Abrahamsson
authors.forename: Niels
authors.initials: N
authors.lastname: Clausen
authors.forename: Göran
authors.initials: G
authors.lastname: Gustafsson
authors.forename: Liisa
authors.initials: L
authors.lastname: Hovi
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Jonmundsson
authors.forename: Bernward
authors.initials: B
authors.lastname: Zeller
authors.forename: Erik
authors.initials: E
authors.lastname: Forestier
authors.forename: Jesper
authors.initials: J
authors.lastname: Heldrup
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003561:Cytarabine / Q000627:therapeutic use; D003582:Cytogenetics; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D018709:Statistics, Nonparametric; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D014740:Vidarabine; C024352:fludarabine