title: Outcome of refractory and relapsed acute myeloid leukemia in children treated during 2005-2011 - experience of the Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG).
abstract: OBJECTIVE
  Recent studies showed relatively better outcome for children with refractory (refAML) and relapsed acute myeloid leukemia (relAML). Treatment of these patients has not been unified within Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG) so far. The goal of this study is to analyze the results of this therapy performed between 2005-2011.
  
  
  METHODS
  The outcome data of 16 patients with refAML and 62 with relAML were analyzed retrospectively. Reinduction was usually based on idarubicine, fludarabine and cytarabine with allogenic hematopoietic stem cell transplant (alloHSCT) in 5 refAML and 30 relAML children.
  
  
  RESULTS
  Seventy seven percent relAML patients entered second complete remission (CR2). Five-year OS and disease-free survival (DFS) were estimated at 16% and 30%. The outcome for patients after alloHSCT in CR2 (63%) was better than that of those not transplanted (36%) with 5-year OS of 34% vs. 2-year of 7% and 5-year DFS of 40% vs. 12.5%. Second complete remission achievement and alloHSCT were the most significant predictors of better prognosis (p = 0.000 and p = 0.024). The outcome of refAML children was significantly worse than relAML with first remission (CR1) rate of 33%, OS and DFS of 25% at 3 years and 53% at 2 years, respectively. All survivors of refAML were treated with alloHSCT after CR1.
  
  
  CONCLUSIONS
  The uniform reinduction regimen of the documented efficacy and subsequent alloHSCT in remission is needed to improve the outcome for ref/relAML children treated within PPLLSG. The focus should be on the future risk-directed both front and second line AML therapy.
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Skalska-Sadowska
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Wachowiak
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Skalska-Sadowska
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Wachowiak
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Zając-Spychała
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Izabela
authors.initials: I
authors.lastname: Niewiadomska-Wojnałowicz
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznan, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Januszkiewicz-Lewandowska
authors.affiliation: Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Walentyna
authors.initials: W
authors.lastname: Balwierz
authors.affiliation: Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Pawińska-Wąsikowska
authors.affiliation: Department of Transplantology, Jagiellonian University Children's Hospital, Krakow, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Goździk
authors.affiliation: Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Chybicka
authors.affiliation: Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Potocka
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Bialystok, Poland.
authors.forename: Maryna
authors.initials: M
authors.lastname: Krawczuk-Rybak
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Bialystok, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Muszyńska-Rosłan
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Gdansk, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Adamkiewicz-Drożyńska
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Gdansk, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Maciejka-Kapuścińska
authors.affiliation: Department of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Karolczyk
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Kowalczyk
authors.affiliation: Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Wójcik
authors.affiliation: Department of Pediatric Hematology and Oncology, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Wanda
authors.initials: W
authors.lastname: Badowska
authors.affiliation: Clinic of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Urasiński
authors.affiliation: Clinic of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Ociepa
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Matysiak
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sikorska-Fic
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szczepański
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Tomaszewska
authors.affiliation: Department of Pediatrics, Medical University of Silesia, Katowice, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Sobol
authors.affiliation: Department of Pediatric Hematology and Oncology, Pediatric Center Chorzow, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Wieczorek
authors.affiliation: Department of Pediatric Hematology and Oncology, Pediatric Center Chorzow, Poland.
authors.forename: Irena
authors.initials: I
authors.lastname: Karpińska-Derda
keywords: acute myeloid leukemia; children; relapse; stem cell transplantation