Oncology Medical News about Childhood acute myeloid leukemia, cytarabine

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Risk-stratified therapy and the intensive use of cytarabine improves the outcome in childhood acute myeloid leukemia: the AML99 trial from the Japanese Childhood AML Cooperative Study Group
Journal of Clinical Oncology, 07/24/09

Tsukimoto I et al. - In a study to improve the prognosis in children with newly diagnosed acute myeloid leukemia (AML) by introducing a dose-dense intensive chemotherapy regimen and an appropriate risk stratification system, it was concluded that a high survival rate, 75.6% at 5 yrs, was achieved for childhood with de novo AML. The treatment strategy was well tolerated with only 1.7% induction death rate and 3.5% remission death rate. Low-risk children were successfully treated with chemotherapy alone.

Methods

240 children with de novo AML were treated with continuous cytarabine-based induction therapy and stratified to 3 risk groups based on initial treatment response, age, and WBC at diagnosis and cytogenetics.
All pts were treated with intensive consolidation chemotherapy including 3 or 4 courses of high-dose cytarabine.
Allogeneic hematopoietic stem-cell transplantation (HSCT) was indicated for only intermediate-risk pts with matched related donors and for all the high-risk subsets.

Results

227 children (94.6%) achieved complete remission (CR).
4 children demonstrated induction death.
Median follow-up of the live pts was 55 mos.
5-yr overall survival of all 240 children was 75.6% and event-free survival was 61.6%.
5-yr disease-free survival in each risk group were 71.3% in the low-risk group (n=112), 59.8% in the intermediate-risk group (n=92), and 56.5% in the high-risk group.
8 children died during the first CR, including 4 after HSCT.

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