Outcome of children treated for relapsed acute myeloid leukemia in Central America.
BACKGROUND
Relapsed childhood acute myeloid leukemia (AML) outcomes have not been documented in resource-limited settings. We examined survival after relapse for children with AML (non-APML) and acute promyelocytic leukemia (APML) in Central America.


METHODS
We retrospectively evaluated outcomes of children with first relapse of AML (non-APML) and APML in Guatemala, Honduras, or El Salvador diagnosed between 1997 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined.


RESULTS
We identified 140 children with relapsed AML (non-APML), and 24 with relapsed APML. Two-year subsequent EFS and OS (±SE) were 7.0 ± 2.5% and 9.1 ± 2.8%, respectively. Worse outcomes were associated with Hispanic or Indigenous heritage, white blood cell count at diagnosis ≥50 × 10(9) /L, and time to relapse <18 months. For those with relapsed APML, subsequent 2-year EFS and OS were 36.7 ± 10.8% and 43.4 ± 12.1%, although few patients survived beyond 3 years. 15.2% of all patients were managed solely with palliative intent following first relapse.


CONCLUSIONS
Children with relapsed AML in Central America rarely survive, so palliative strategies should be considered following relapse in this population. However, children with late relapse or with APML may have a prolonged period of remission with second treatment, and consideration of re-treatment may be appropriate.
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
Stacey
S
Marjerrison
Federico
F
Antillon
Miguel
M
Bonilla
Ligia
L
Fu
Roxana
R
Martinez
Patricia
P
Valverde
Roberto
R
Vasquez
Scott C
SC
Howard
Raul C
RC
Ribeiro
Lillian
L
Sung
D000293:Adolescent; D002489:Central America / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
acute myeloid leukemia; child; developing country; low-income country; middle-income country; relapse