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Published on: September 19, 2013
Outcome of Intensive Therapy for Children with Relapsed Acute Myeloid Leukemia: A Single Institution Korean Study
Jae Wook Lee1, Jae Won Yoo1, Seongkoo Kim1
1Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Intensive therapy offers long-term survival for pediatric acute myeloid leukemia (AML) patients who relapse. Approximately 50% of patients achieving second remission survive, regardless of prior treatments.
Area of Science:
- Pediatric Hematology Oncology
- Leukemia Research
- Cancer Therapeutics
Background:
- Relapse occurs in 30%-40% of pediatric acute myeloid leukemia (AML) patients.
- Understanding outcomes for relapsed AML is critical for improving survival.
- First-line therapy effectiveness influences relapse prognosis.
Purpose of the Study:
- To analyze the outcomes of pediatric AML patients experiencing first relapse.
- To identify prognostic factors influencing survival in relapsed pediatric AML.
- To evaluate the impact of prior treatment modalities on relapse outcomes.
Main Methods:
- Retrospective analysis of 50 pediatric AML patients diagnosed between April 2009 and December 2018 with first relapse.
- Detailed review of first-line treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR).
- Assessment of response to intensive chemotherapy at relapse and identification of prognostic factors.
Main Results:
- 90% of patients received intensive chemotherapy at relapse, with 76% achieving second CR.
- Estimated 5-year overall survival was 44.9% for patients treated at relapse.
- Time to relapse and extramedullary involvement (EMI) at diagnosis were significant negative prognostic factors.
Conclusions:
- Intensive therapy can lead to long-term survival in 40%-50% of relapsed pediatric AML patients.
- Achieving second CR offers a favorable prognosis, with approximately 50% survival, irrespective of prior treatment.
- Intensive treatment strategies are vital for salvaging a significant proportion of pediatric AML patients with relapsed disease.
Purpose:
Approximately 30%-40% of pediatric acute myeloid leukemia (AML) patients relapse. In this study, we analyzed the outcome and prognostic factors of relapsed AML patients who had previously received first-line therapy at our institution.
Materials And Methods:
The study group consisted of 50 patients who had been diagnosed with AML from April 2009 to December 2018, and then showed first relapse. Thirty-two of the patients (64%) had previously received allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR).
Results:
Forty-five of the patients (90%) received intensive chemotherapy upon diagnosis of relapse, and 76% (34/45) of these patients achieved a second CR. Estimated 5-year overall survival for these 45 patients was 44.9%±7.6%. Time from diagnosis to relapse, extramedullary involvement (EMI) at diagnosis, core binding factor AML, and complex karyotype were significant prognostic factors; in multivariate study, both time from diagnosis to relapse and EMI at diagnosis proved significant. There was no difference in 5-year disease-free survival between patients previously treated with chemotherapy only and those who received HSCT in first CR (52.4%±14.9% vs. 52.6%±11.5%). Of the 19 patients who achieved second CR after previous allogeneic HSCT in first CR and subsequent relapse, 11 were treated with chemotherapy only, and seven survive disease-free.
Conclusion:
Intensive therapy allowed for long-term survival in 40%-50% of patients, and 50% of patients who achieved second CR, regardless of prior treatment modalities in first CR. Intensive treatment may allow for salvage of a significant portion of patients with relapsed pediatric AML.
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