Postremission therapy for children with acute myeloid leukemia: the children's cancer group experience in the transplant era

• Published in: Leukemia Vol. 19; no. 6; pp. 965 - 970
• Main Authors: ALONZO, T. A, WELLS, R. J, WOODS, W. G, LANGE, B, GERBING, R. B, BUXTON, A. B, NEUDORF, S, SANDERS, J, SMITH, F. O, FEIG, S. A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01-06-2005; Nature Publishing Group
• Subjects: Acute Disease; Acute myeloid leukemia; Antineoplastic Agents - therapeutic use; Autografts; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Cancer; Cancer therapies; Chemotherapy; Child; Children; Children & youth; Combined Modality Therapy; Consolidation; Diagnostic systems; Graft versus host disease; Hematologic and hematopoietic diseases; Hospitals; Humans; Karyotyping; Leukemia; Leukemia, Myeloid - genetics; Leukemia, Myeloid - mortality; Leukemia, Myeloid - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocytes; Medical sciences; Oncology; Outcome Assessment (Health Care); Prognosis; Remission; Remission (Medicine); Remission Induction; Stem cell transplantation; Survival Analysis; Transplantation; Transplantation, Autologous; Transplants; Transplants & implants; Los Angeles California; United States > US; Human; Antineoplastic agent; Hematology; Acute; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; Transplantation; Malignant tumor; Consolidation treatment; bone marrow transplantation; Chemotherapy; acute myeloid leukemia; children; Surgery; Cytogenetics; Bone marrow; Graft; Child; Karyotype; Acute myelocytic leukemia
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2403763

We reviewed consolidation therapy results and analyzed postremission outcomes for 1464 children less than 21 years old at diagnosis in five consecutive Children's Cancer Group acute myeloid leukemia trials between 1979 and 1996. Children in remission were allocated to allogeneic bone marrow transplantation (BMT) (N=373) in first remission, if a matched family donor was available. Remaining children were assigned consolidation chemotherapy (N=688) or autologous purged BMT (N=217), or withdrew from study before assignment, or with unknown data (N=186). Overall and disease-free survival were superior for children assigned allogeneic transplants. High (>50,000/microl) diagnostic white blood cell (WBC) count was prognostic for inferior outcome, but French-American-British (FAB) subtypes were not. Inv(16) is a favorable karyotypic feature for children in first remission and t(8;21) is not. Allogeneic transplantation benefit was evident in most children, including those with high or low diagnostic WBC count, each FAB subtype, and t(8;21), but was not seen in children with inv(16). Therefore, these data suggest reserving matched related donor allogeneic transplantation for children with inv(16) for second remission, but not those with t(8;21).