Treatment of acute myelogenous leukemia in children

Progress in the treatment of childhood AML has not equalled the advances obtained in the management of ALL. Two recent chemotherapy studies (i.e. VAPA and BFM 78), however, reported marked increase in the proportion of long-term remissions. The initial therapy of the cooperative study BFM 78 consisted of two 4-week phases of intensive induction/consolidation with 7 different drugs and cranial irradiation followed by maintenance with thioguanine and cytosine arabinoside for 2 years and additional adriamycin during the first year. A total of 151 children with AML were enrolled in the study from 30 centers. Of these 119 (79%) patients achieved complete remission. After a median observation time of 34 (14-57) months, there have been 46 relapses. CNS was involved in 6 of these relapses. Life table analyses revealed the following probabilities after 4 1/2 years: survival: 46%; disease-free survival: 41% (total group), 52% (remission group); disease-free interval 56% (remission group). The risk of relapse appears to decrease considerably after 2 1/2 years. No risk factors for the occurrence of relapse have been identified.