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Acute Leukemias

Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials

Leukemia volume 24, pages 1422–1428 (2010)Cite this article

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Abstract

Relapse remains the major cause of treatment failure in pediatric acute myeloid leukemia (AML). We analyzed the clinical characteristics, treatment response to relapse treatment and overall survival (OS) of 379 children with AML relapse treated according to three consecutive frontline protocols of the AML-Berlin/Frankfurt/Muenster study group (AML-BFM-87/-93/-98). Of 313 treated patients with data on remission status, 198 children (63%) achieved a second complete remission (CR2). There were no significant differences in remission rates and OS for the intensive reinduction treatment schedules used. The 5-year OS rate was 23% for the total group and 29% for patients treated with curative intent. OS rates increased with study periods from 18 to 34% (Plog rank=0.012), whereas the proportion of patients receiving only palliative treatment decreased from 23 to 11% (PCMH=0.005). Late relapse, no allogeneic stem cell transplantation (SCT) in CR1, age <10 years and favorable cytogenetics were independent favorable prognostic factors for survival. Achievement of CR2 was the most important prognostic factor (OS 44 vs 3%; Plog rank<0.0001). Overall, one-third of children with relapsed AML can be cured today. SCT in CR2 is recommended for most patients, although its impact on CR2 is discussed.

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Acknowledgements

The AML-BFM-REZ-97 trial was supported by German José Carreras Foundation. The names of the principal investigators of the AML-BFM trials in different countries are provided in Supplementary Information. We appreciate the assistance of Ursula Bernsmann, Jans-Enno Müller and Dr Gesche Tallen in the preparation of this paper.

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Authors and Affiliations

  1. Department of Pediatric Hematology/Oncology, Medical School Hannover, Hannover, Germany

    A Sander, M Zimmermann, C von Neuhoff & D Reinhardt

  2. Children's Cancer Research Institute and St Anna Children's Hospital, Vienna, Austria

    M Dworzak

  3. Department of Pediatric Hematology/Oncology/, Children's Hospital Medical Center, University of Bonn, Germany

    G Fleischhack

  4. Department of Pediatric Hematology/Oncology, VU Medical Center, Amsterdam, The Netherlands

    G J L Kaspers

  5. Department Hematology/Oncology, University of Muenster, Muenster, Germany

    U Creutzig

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  1. A Sander
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  2. M Zimmermann
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Correspondence to A Sander.

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Sander, A., Zimmermann, M., Dworzak, M. et al. Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials. Leukemia 24, 1422–1428 (2010). https://doi.org/10.1038/leu.2010.127

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