Related Experiment Video
Updated: Aug 29, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
[Acute myeloid leukemia in childhood: 15-year experience in a single institution]
Marcos B Viana1, Keyla C C M S Cunha, Gilberto Ramos
1Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. vianamb@medicina.ufmg.br
Insights
The German-based protocol significantly improved survival rates for children with acute myeloid leukemia (AML). However, adding etoposide unexpectedly reduced remission rates, with no clear reason found.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute myeloid leukemia (AML) in children presents significant treatment challenges.
- Treatment protocols evolve to improve patient outcomes.
- The Berlin-Frankfurt-Munich-83 (BFM-83) protocol represents a standardized approach in pediatric oncology.
Purpose of the Study:
- To evaluate the impact of a BFM-83 based protocol on pediatric AML survival.
- To analyze prognostic factors including age, gender, nutritional status, white blood cell count, and etoposide use.
- To compare outcomes before and after protocol implementation.
Main Methods:
- A partly prospective/retrospective study of 83 pediatric AML patients (1986-2000).
- Comparison of treatment regimens before and after 1991, including a pilot study of etoposide.
- Randomized etoposide use in the induction phase from 1992 to 1999.
Main Results:
- Improved remission rates (40% to 66%) after protocol introduction (p=0.11).
- 5-year survival and remission probabilities were 31% and 49.7%, respectively.
- Younger age (<6 years) was a poor prognostic factor; etoposide unexpectedly decreased remission probability.
Conclusions:
- The BFM-83 based protocol significantly enhanced survival and remission duration in pediatric AML.
- No clear explanation was identified for the negative impact of etoposide on remission rates.
- Further research is needed to understand etoposide's role in pediatric AML induction.
Objective:
To investigate the survival of children with acute myeloid leukemia (AML) before and after the introduction of a Berlin-Frankfurt-Munich-83 based protocol. To analyze the prognostic impact of age, gender, nutritional status, initial white blood cell count and use of etoposide in the remission induction phase.
Methods:
This partly prospective/retrospective study comprised 83 children with AML diagnosed at Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 1986 and 2000. Before 1991, 15 children were treated with 2-3 pulses of cytarabin plus daunomycin, followed by several consolidation/maintenance schemes. From January 1991 to November 1992 a pilot study (n = 15) was carried out to test etoposide toxicity in the induction phase. Etoposide was randomized from December 1992 to June 1999.
Results:
Median follow-up period was 5 years. Initial remission rates were 40 and 66% before or after the introduction of the German protocol, respectively (p = 0.11). Induction failure was largely due to death caused by infection and/or hemorrhage. The 5-year estimated probabilities of survival and of continuous complete remission were 31+/-5.4% and 49.7+/-7.4%, respectively. All 22 relapses involved the bone marrow. Age below 6 years at diagnosis was significantly associated with a poor prognosis. Sex, initial leukocyte count, and nutritional variables were not significant prognostic factors. The randomized addition of etoposide in the induction phase unexpectedly decreased the probability of complete remission at 5 years.
Conclusions:
The introduction of a German-based protocol in 1991 significantly improved survival and duration of first remission. No plausible explanation for the unfavorable effect of etoposide was found.
