1. ¹Department of Haematology, Oncology, University Children's Hospital, Münster, Germany
2. ²Department of Haematology, Oncology, University Children's Hospital, Hannover, Germany
3. ³Department of Haematology, Oncology, University Children's Hospital, Jena, Germany
4. ⁴Department of Haematology, Oncology, University Children's Hospital, Berlin, Germany
5. ⁵Department of Haematology, Oncology, University Children's Hospital, Hamburg, Germany
6. ⁶Department of Haematology, Oncology, University Children's Hospital, Giessen, Germany
7. ⁷Children's Cancer Research Institute and St Anna Kinderspital, Vienna, Austria

Correspondence: Professor U Creutzig, Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany. Fax: +49 251 83 56489; E-mail: ursula@creutzig.de

Received 14 December 2004; Accepted 10 May 2005; Published online 15 September 2005.

Abstract

A total of 1111 children with acute myeloblastic leukaemia (AML) were treated in four consecutive Berlin–Frankfurt–Münster (BFM) studies from 1978 to 1998. The first cooperative trial AML-BFM 78 established intensive chemotherapy with seven drugs, CNS irradiation and 2-year maintenance, achieving a long-term survival (overall survival (OS)) of 40%. Induction intensification in AML-BFM 83 resulted in significant improvement of disease-free survival (DFS). The risk of haemorrhage, especially in children with hyperleukocytosis, proved the high relevance of supportive care. In AML-BFM 87, the benefit of CNS irradiation in preventing CNS/systemic relapses was demonstrated. In AML-BFM 93, the introduction of idarubicin during first induction followed by intensification with HAM increased the 5-year EFS, DFS and OS to 502, 613 and 572%, respectively. Stem cell transplantation (SCT), as applied in high-risk patients with a matched related donor, did not significantly improve the outcome compared to chemotherapy alone. In spite of treatment intensification, the therapy-related death rate decreased from trial to trial, mainly during induction. The future aim is to reduce long-term sequelae, especially cardiotoxicity, by administration of less cardiotoxic drugs, and toxicity of SCT by risk-adapted indications. The AML-BFM studies performed in three European countries with >70 cooperating centres have significantly improved the outcome in AML children; nevertheless, increasing experience with these intensive treatment regimens is of fundamental importance to reduce fatal complications.