Response-Guided Induction Therapy in Pediatric Acute Myeloid Leukemia With Excellent Remission Rate

被引:150
作者
Abrahamsson, Jonas
Forestier, Erik
Heldrup, Jesper
Jahnukainen, Kirsi
Jonsson, Olafur G.
Lausen, Birgitte
Palle, Josefine
Zeller, Bernward
Hasle, Henrik
机构
[1] Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Gothenburg, Sweden
[2] Umea Univ, Umea, Sweden
[3] Univ Hosp Lund, Lund, Sweden
[4] Univ Childrens Hosp, Uppsala, Sweden
[5] Univ Helsinki, Hosp Children & Adolescents, Helsinki, Finland
[6] Landspitali Univ Hosp, Childrens Hosp Iceland, Reykjavik, Iceland
[7] Rigshosp, Univ Hosp, Copenhagen, Denmark
[8] Aarhus Univ, Hosp Skejby, Aarhus, Denmark
[9] Oslo Univ Hosp, Rikshosp, Oslo, Norway
关键词
BONE-MARROW-TRANSPLANTATION; ACUTE MYELOBLASTIC-LEUKEMIA; TRIAL COMPARING IDARUBICIN; DIRECTED THERAPY; ADULT PATIENTS; AML; CHILDREN; DAUNORUBICIN; CYTARABINE; IMPROVES;
D O I
10.1200/JCO.2010.30.6829
中图分类号
R73 [肿瘤学];
学科分类号
100214 [肿瘤学];
摘要
Purpose To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course. Patients and Methods All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (>= 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine, cytarabine, and granulocyte colony-stimulating factor. Poor responders received allogeneic stem-cell transplantation (SCT) as consolidation. Results Seventy-four percent of patients had good response, 17% had intermediate response, and 7% had poor response after the first course. The overall remission frequency was 97.4%, with 92% in remission after the second course. The rate of induction death was 1.3%. Patients with an intermediate response had a lower event-free survival of 35% compared with good (61%) and poor responders (82%). Conclusion The NOPHO-AML 2004 induction strategy gives an excellent remission rate with low toxic mortality in an unselected population. Outcome is worse in patients with intermediate response but may be improved by intensifying consolidation in this group using SCT.
引用
收藏
页码:310 / 315
页数:6
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