title: Definition of cure in childhood acute myeloid leukemia.
abstract: BACKGROUND
  A better understanding of when cure can be declared in childhood acute myeloid leukemia (AML) would reduce anxiety and improve quality of life of AML survivors. The authors determined the likelihood that patients with AML would maintain long-term remission after the completion of therapy.
  
  
  METHODS
  The cumulative risk of relapse, the time to relapse, event-free survival, and overall survival were analyzed for 604 patients with AML who were enrolled in 7 successive clinical trials divided into 3 treatment eras (1976-1991, 1991-1997, and 2002-2008).
  
  
  RESULTS
  The median time to relapse did not change over time (0.93 years vs 0.76 years vs 0.8 years, respectively, for each consecutive era; P = .22), but the risk of relapse decreased significantly (5-year cumulative incidence of relapse: 52.6% ± 3.1% vs 31.5% ± 3.9% vs 22% ± 3%, respectively, for each consecutive era; P < .001). Among patients who were in remission 4 years from diagnosis, the probabilities of relapse were 1.7%, 2.9%, and 0.9%, respectively, for each consecutive era. In the most recent era, all but 1 of 44 relapses occurred within 4 years of diagnosis.
  
  
  CONCLUSIONS
  Children with AML who receive treatment with contemporary therapy and remain in remission 4 years from diagnosis probably are cured. Although late relapses and late deaths from other causes are rare, long-term follow-up of survivors is necessary for the timely management of late adverse effects.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inaba
authors.forename: Wing H
authors.initials: WH
authors.lastname: Leung
authors.forename: Stanley
authors.initials: S
authors.lastname: Pounds
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Cao
authors.forename: Dario
authors.initials: D
authors.lastname: Campana
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: D002648:Child; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
keywords: acute myeloid leukemia; childhood; relapse; treatment era