title: Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol.
abstract: The outcomes of children with relapsed acute myeloid leukemia (AML) are known to be poor, but remain obscure. We retrospectively analyzed 71 patients who had relapsed following first-line treatment under the AML99 protocol. We investigated the time and site of recurrence, response to re-induction therapy, and performance of hematopoietic stem cell transplantation (HSCT) in relapsed cases, and performed a multivariate analysis to identify prognostic factors. The 5-year overall-survival (OS) rate after relapse was 37 %. Of 71 patients, three died without any anti-leukemic therapy and two underwent allogeneic HSCT. The remaining 66 patients received re-induction chemotherapy, and 33 (50 %) achieved second CR (CR2). Twenty-two of 25 (88 %) late relapse patients and 11 of 41 (27 %) early relapse patients achieved CR2 (P < 0.001). Twenty-nine CR2 cases and 35 non-CR2 cases underwent allogeneic HSCT. The 5-year OS rate was significantly higher in patients who underwent HSCT in CR2 than those in non-CR2 (66 vs. 17 %, P < 0.000001). Multivariate analysis indicated that early relapse (P < 0.05) and the positivity of the FMS-like tyrosine kinase 3--internal tandem duplication (P < 0.05) were adverse prognostic factors for survival. In conclusion, the etiology of relapsed pediatric AML needs to be elucidated and effective chemotherapy should be administered to obtain CR2.
authors: Department of Pediatrics, National Hospital Organization, Fukuoka-Higashi Medical Center, Chidori 1-1-1, Koga, Fukuoka, 811-3195, Japan, hnkym415@gmail.com.
authors: Hideki
authors: H
authors: Nakayama
authors: Ken
authors: K
authors: Tabuchi
authors: Akio
authors: A
authors: Tawa
authors: Ichiro
authors: I
authors: Tsukimoto
authors: Masahiro
authors: M
authors: Tsuchida
authors: Akira
authors: A
authors: Morimoto
authors: Hiromasa
authors: H
authors: Yabe
authors: Keizo
authors: K
authors: Horibe
authors: Ryoji
authors: R
authors: Hanada
authors: Masue
authors: M
authors: Imaizumi
authors: Yasuhide
authors: Y
authors: Hayashi
authors: Kazuko
authors: K
authors: Hamamoto
authors: Ryoji
authors: R
authors: Kobayashi
authors: Kazuko
authors: K
authors: Kudo
authors: Akira
authors: A
authors: Shimada
authors: Takako
authors: T
authors: Miyamura
authors: Hiroshi
authors: H
authors: Moritake
authors: Daisuke
authors: D
authors: Tomizawa
authors: Takashi
authors: T
authors: Taga
authors: Souichi
authors: S
authors: Adachi
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D020440:Gene Duplication; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D051941:fms-Like Tyrosine Kinase 3 / Q000235:genetics* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D051941:fms-Like Tyrosine Kinase 3; D015255:Idarubicin