Association between prolonged neutropenia and reduced relapse risk in pediatric AML: A report from the children's oncology group.
Objective was to describe the relationship between the number of sterile site infections and duration of neutropenia during the first four cycles of chemotherapy and the risk of recurrence and overall survival in children with newly diagnosed acute myeloid leukemia (AML). AAML0531 was a Children's Oncology Group randomized phase 3 clinical trial that included 1022 children with de novo AML. For this analysis, we focused on non-Down syndrome favorable and standard risk patients who completed at least 4 cycles of chemotherapy without recurrence or withdrawal during protocol therapy. Those receiving hematopoietic stem cell transplantation in first remission were excluded. Five hundred and sixty-nine patients were included; 274 (48.2%) were favorable risk. The median cumulative time with neutropenia between Induction II to completion of Intensification II was 96 (range 54-204) days. Number of sterile site infections did not influence the risk of relapse or overall survival. However, longer duration of neutropenia was associated with a lower risk of relapse (hazard ratio 0.81 per 20 days neutropenia, p = 0.007). Longer duration of neutropenia was associated with a reduced risk of relapse for children with favorable and standard risk AML. Toxicity may be influenced by pharmacogenomics suggesting that individualized chemotherapy dosing may be an effective strategy.
The Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
Lillian
L
Sung
Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Richard
R
Aplenc
Children's Oncology Group, Monrovia, CA, USA.|Department of Biostatistics, University of Southern California, Los Angeles, CA, USA.
Todd A
TA
Alonzo
Children's Oncology Group, Monrovia, CA, USA.
Robert B
RB
Gerbing
Children's Oncology Group, Monrovia, CA, USA.
Yi-Cheng
YC
Wang
Division of Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Soheil
S
Meshinchi
Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
Alan S
AS
Gamis
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D009503:Neutropenia / Q000139:chemically induced*; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016896:Treatment Outcome
acute myeloid leukemia; neutropenia; oncology; pediatric; relapse risk