Related Experiment Video
Updated: Jul 17, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Improved outcome after relapse in children with acute myeloid leukaemia
Jonas Abrahamsson1, Niels Clausen, Göran Gustafsson
1Department of Clinical Sciences, Queen Silvia's Childrens Hospital, Gothenburg, Sweden. jonas.abrahamsson@vgregion.se
Insights
Many children with relapsed acute myeloid leukaemia (AML) can be cured. Factors like late relapse and stem cell transplantation (SCT) significantly improve survival rates in pediatric AML patients.
Area of Science:
- Paediatric Haematology and Oncology
- Clinical Paediatrics
- Cancer Research
Background:
- The Nordic Society for Paediatric Haematology and Oncology (NOPHO) AML 93 study reported 50% event-free survival and 66% overall survival.
- Relapse in childhood acute myeloid leukaemia (AML) presents a significant challenge, necessitating investigation into factors influencing patient outcomes.
Purpose of the Study:
- To investigate prognostic factors influencing survival in children with relapsed acute myeloid leukaemia (AML).
- To evaluate the effectiveness of re-induction therapy and stem cell transplantation (SCT) in improving outcomes for pediatric AML patients post-relapse.
Main Methods:
- Analysis of data from 146 children diagnosed with AML in Nordic countries between 1988 and 2003 who experienced relapse.
- Correlation of disease characteristics and relapse treatment strategies, including re-induction therapy and SCT, with patient survival outcomes.
Main Results:
- Sixty-six percent of patients achieved remission post-relapse, with a 5-year survival rate of 34%.
- Re-induction therapy led to remission in 77% of patients, with a 40% survival rate. Fludarabine-based regimens showed low treatment-related mortality.
- Prognostic factors for improved survival included longer first complete remission (CR1) duration and SCT during CR1. Late relapse (>1 year in CR1) significantly improved survival compared to early relapse (<1 year). Survival reached 62% for patients receiving SCT as part of relapse therapy.
Conclusions:
- A significant proportion of children with relapsed AML can achieve a cure, including those with early relapse.
- Children undergoing re-induction therapy, achieving remission, and proceeding to SCT have a potential cure rate of approximately 60%.
- Late relapse and the use of SCT as part of relapse therapy are key factors associated with better survival in pediatric AML.
Abstract:
In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty-six percentage achieved remission with survival after relapse (5 years) 34 +/- 4%. Of 122 patients who received re-induction therapy, 77% entered remission with 40 +/- 5% survival. Remission rates were similar for different re-induction regimens but fludarabine, cytarabine, granulocyte colony-stimulating factor-based therapy had low treatment-related mortality. Prognostic factors for survival were duration of first complete remission (CR1) and stem cell transplantation (SCT) in CR1. In early relapse (<1 year in CR1), survival was 21 +/- 5% compared with 48 +/- 6% in late relapse. For children receiving re-induction therapy, survival in early relapse was 29 +/- 6% and 51 +/- 6% in late. Patients treated in CR1 with SCT, autologous SCT or chemotherapy had a survival of 18 +/- 9, 5 +/- 5 and 41 +/- 5%, respectively. Survival was 62 +/- 6% in 64 children given SCT as part of their relapse therapy. A significant proportion of children with relapsed AML can be cured, even those with early relapse. Children who receive re-induction therapy, enter remission and proceed to SCT can achieve a cure rate of 60%.
