title: Response-guided induction therapy in pediatric acute myeloid leukemia with excellent remission rate.
abstract: OBJECTIVE
  To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course.
  
  
  METHODS
  All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (≥ 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine, cytarabine, and granulocyte colony-stimulating factor. Poor responders received allogeneic stem-cell transplantation (SCT) as consolidation.
  
  
  RESULTS
  Seventy-four percent of patients had good response, 17% had intermediate response, and 7% had poor response after the first course. The overall remission frequency was 97.4%, with 92% in remission after the second course. The rate of induction death was 1.3%. Patients with an intermediate response had a lower event-free survival of 35% compared with good (61%) and poor responders (82%).
  
  
  CONCLUSIONS
  The NOPHO-AML 2004 induction strategy gives an excellent remission rate with low toxic mortality in an unselected population. Outcome is worse in patients with intermediate response but may be improved by intensifying consolidation in this group using SCT.
authors.affiliation: Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, 41685 Gothenburg, Sweden. jonas.abrahamsson@vgregion.se
authors.forename: Jonas
authors.initials: J
authors.lastname: Abrahamsson
authors.forename: Erik
authors.initials: E
authors.lastname: Forestier
authors.forename: Jesper
authors.initials: J
authors.lastname: Heldrup
authors.forename: Kirsi
authors.initials: K
authors.lastname: Jahnukainen
authors.forename: Olafur G
authors.initials: OG
authors.lastname: Jónsson
authors.forename: Birgitte
authors.initials: B
authors.lastname: Lausen
authors.forename: Josefine
authors.initials: J
authors.lastname: Palle
authors.forename: Bernward
authors.initials: B
authors.lastname: Zeller
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005387:Finland; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007055:Iceland; D015255:Idarubicin / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D011994:Recombinant Proteins; D012074:Remission Induction / Q000379:methods; D018570:Risk Assessment; D012537:Scandinavian and Nordic Countries; D016019:Survival Analysis
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D015255:Idarubicin