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Survival Following Relapse in Children with Acute Myeloid Leukemia: A Report from AML-BFM and COG

Mareike Rasche1, Martin Zimmermann2, Emma Steidel1

  • 1Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, 45147 Essen, Germany.

Cancers
|June 2, 2021
PubMed

Insights

Post-relapse therapy is crucial for children with acute myeloid leukemia (AML). High-risk features and early relapse significantly impact survival, while initial response recovery doesn't predict outcomes.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Trials

Background:

  • Post-relapse therapy is critical for improving survival rates in pediatric acute myeloid leukemia (AML).
  • Understanding prognostic variables after relapse is essential for optimizing treatment strategies.
  • Independent cooperative group studies provide robust data for evaluating treatment outcomes.

Purpose of the Study:

  • To evaluate survival, response, and prognostic factors in children with relapsed AML.
  • To compare outcomes between the Children's Oncology Group (COG) and the AML-BFM study group.
  • To identify key factors influencing survival after relapse in pediatric AML.

Main Methods:

  • Analysis of two independent datasets: COG (852 patients) and AML-BFM (197 patients).
  • Evaluation of overall survival (OS) at 5 years, response to re-induction therapy, and impact of hematopoietic stem cell transplant (HSCT).
  • Assessment of prognostic variables including initial high-risk features and time to relapse.

Main Results:

  • Five-year overall survival (OS) was 42% (BFM) and 35% (COG).
  • Initial high-risk features and early relapse were associated with diminished survival.
  • No significant difference in OS was observed based on the degree of hematopoietic recovery (CR vs. CRp/CRi) after re-induction therapy.

Conclusions:

  • Initial high-risk features and early relapse are significant negative prognostic indicators in pediatric AML.
  • Hematopoietic recovery status after initial relapse therapy does not predict survival outcomes.
  • There is a need for refined post-relapse risk stratification in future pediatric AML relapse studies, with HSCT showing promising survival rates (54%).

Keywords:
acute myeloid leukemiachildhood acute myeloid leukemiapediatricrelapsesalvage therapy

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