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Treatment of childhood acute myeloid leukaemia using the BFM-83 protocol
P C Sartori1, M H Taylor, M C Stevens
1Department of Haematology, Birmingham Children's Hospital, England.
Insights
This study on acute nonlymphoblastic leukaemia in children achieved a 5-year survival rate of 47% using the AML-BFM-83 protocol. The treatment offers long-term remission potential with manageable inpatient resource utilization.
Area of Science:
- Pediatric Oncology
- Hematology
Background:
- Acute nonlymphoblastic leukaemia (ANLL) is a significant pediatric cancer.
- Effective treatment protocols are crucial for improving outcomes in children with ANLL.
Purpose of the Study:
- To evaluate the efficacy and resource demands of the AML-BFM-83 protocol in treating pediatric acute nonlymphoblastic leukaemia.
- To assess long-term remission, survival rates, and event-free survival in children treated with this protocol.
Main Methods:
- A cohort of 30 children with ANLL were treated using the AML-BFM-83 protocol, including induction, consolidation, and continuation phases.
- The protocol involved multiple chemotherapy agents and cranial irradiation.
- Outcomes were analyzed using life table analysis with a median follow-up of 60 months.
Main Results:
- Complete remission was achieved in 83% of patients (25 out of 30).
- At 5 years, the probability of survival was 47%, event-free survival was 43%, and event-free interval was 50%.
- Nine relapses occurred, all in the bone marrow. Median bed occupancy was 41 days.
Conclusions:
- The AML-BFM-83 protocol can achieve long-term remissions in nearly half of children with ANLL.
- The treatment protocol demonstrates modest demands on inpatient resources.
- Further research into optimizing ANLL treatment for pediatric patients is warranted.
Abstract:
Thirty children presenting with acute nonlymphoblastic leukaemia from June 1984 to December 1989 were treated at one UK centre using a West German protocol, AML-BFM-83. This consisted of Induction, an intensive outpatient-based Consolidation regimen with seven different drugs and cranial irradiation, and Continuation therapy with thioguanine and cytosine arabinoside for 2 years with additional Adriamycin in the first year. Twenty-five children achieved complete remission (83%). There were two early deaths from haemorrhage and infection and three from Induction failure. After a median follow-up time of 60 months, nine relapses have occurred, all in the bone marrow. Life table analysis revealed a probability for survival at 5 years of 47%, event-free survival 43%, and event-free interval 50%. Median bed occupancy for chemotherapy and toxicity was 41 days, with median hospital stays of 29 days for Induction, 11 days for Consolidation and less than 1 day for Continuation. This data suggests that long-term remissions can be achieved in just under half of children with acute nonlymphoblastic leukaemia while creating only modest demands on inpatient resources.