Cancer Res Treat.  2022 Oct;54(4):1230-1239. 10.4143/crt.2021.1011.

Outcome of Intensive Therapy for Children with Relapsed Acute Myeloid Leukemia: A Single Institution Korean Study

• Lee JW
• Yoo JW
• Kim S
• Jang PS
• Chung NG
• Cho B

• KMID: 2534202
• DOI: http://doi.org/10.4143/crt.2021.1011

Abstract

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.

Keyword

Acute myeloid leukemia; Children; Relapse; Hematopoietic stem cell transplantation; Extramedullary involvement

Figure

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  Fig. 1 Flow chart of relapsed acute myeloid leukemia study group. CR, complete remission; DFS, disease-free survival; OS, overall survival.

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  Fig. 2 (A) Estimated disease-free survival (DFS) for the 34 patients who received intensive chemotherapy and achieved second complete remission. (B) Estimated overall survival (OS) for the 45 patients who received intensive chemotherapy.

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  Fig. 3 Estimated overall survival for the 45 patients who received intensive chemotherapy according to time from diagnosis to relapse (< 12 months from diagnosis to relapse vs. ≥ 12 months from diagnosis to relapse) (A), extramedullary involvement (EMI) at diagnosis (B), presence of core binding factor (CBF) acute myeloid leukemia (AML) (C), and presence of complex karyotype (D).

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  Fig. 4 Disease characteristics, treatment in first complete remission (CR), response to reinduction chemotherapy and outcome for the 45 patients who received intensive chemotherapy. CBF, core binding factor; RI, remission induction. a)Genetic abnormalities at diagnosis of acute myeloid leukemia (AML), b)Achieved complete remission after one course of chemotherapy after initial diagnosis, c)Patient 20 did not achieve second CR after reinduction chemotherapy, and only achieved second CR after the second allogeneic hematopoietic stem cell transplantation (HSCT).

Reference

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