title: Strategies for reducing the treatment-related physical burden of childhood acute myeloid leukaemia - a review.
abstract: Over the last four decades the survival of paediatric patients with acute myeloid leukaemia has gradually increased to 70% in high-income countries. The therapy is very intensive and associated with many acute and long-term side effects. The early death rate has been reduced to 1-4%. The acute toxicity is a limiting factor for improving survival in low-income countries. Transplant is associated with more endocrinological late effects while cardiotoxicity is more common after relapse. Reducing the physical costs of therapy without jeopardizing survival may be accomplished by optimal supportive care, less cardiotoxic anthracyclines, less consolidation courses and strict indications for stem cell transplantation. Analysing scenarios with different frequency of transplantation in first complete remission show similar overall survival rates, indicating that almost all patients can be spared the procedure in first remission. Reducing relapse risk is an effective way of reducing toxicity and more targeted therapy and improved risk group stratifications are needed.
authors.affiliation: Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
authors.affiliation: Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.|Academy of Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
authors.forename: Gertjan J L
authors.initials: GJ
authors.lastname: Kaspers
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D066126:Cardiotoxicity / Q000209:etiology; D002648:Child; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D055502:Secondary Prevention; D033581:Stem Cell Transplantation / Q000379:methods
keywords: acute myeloid leukaemia; childhood leukaemia; late effects