1. ¹Clinica Pediatrica, Università di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
2. ²Oncoematologia Pediatrica, Università di Padova, Padova, Italy
3. ³Clinica Pediatrica, Ospedale Nuovo San Gerardo, Monza, Italy
4. ⁴Ematologia, Università La Sapienza di Roma, Roma, Italy
5. ⁵Clinica Pediatrica, Università di Torino, Ospedale Infantile Regina Margherita, Torino, Italy
6. ⁶Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Pavia, Italy

Correspondence: Prof A Pession, Oncoematologia Pediatrica, Via Massarenti, 11 – 40138 Bologna, Italy; Fax: +39 51 346044; E-mail: andrea.pession@unibo.it

Received 20 December 2004; Accepted 9 June 2005; Published online 18 August 2005.

Abstract

Since 1982, four consecutive studies on childhood acute myeloid leukaemia (AML) (namely LAM-82, -87, -87M and -92) have been conducted in Italy by the Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP) group. The induction therapy of the first three studies consisted of daunorubicin and cytarabine structured in a 3+7 backbone. In the most recent protocol (LAM92), patients received two induction courses including idarubicin, cytarabine and etoposide. Patients with acute promyelocytic leukaemia (20% of diagnoses) were included in LAM-87 and 87M studies. Postremissional therapy significantly changed over time, with an ever-increasing role given to stem cell transplantation (SCT). The long-term outcome of patients enrolled in the LAM-82, 87 and 87M studies was comparable, whereas that of children treated according to LAM-92 study was significantly better (P<0.005). Either allogeneic or autologous SCT was employed as consolidation therapy in more than 75% of cases enrolled in this latter study. Patients enrolled in the LAM-92 study were stratified in standard and high-risk groups with different outcome (67 vs 47%, respectively, P=0.04). Altogether, the results obtained in these four studies have permitted a progressive refinement of treatment, contributing to the structure of the ongoing LAM-2002 protocol that stratifies patients according to the presence of definite genetic anomalies and response to induction therapy.