International Journal of Hematology

, Volume 100, Issue 2, pp 171–179 | Cite as

Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol

  • Hideki NakayamaEmail author
  • Ken Tabuchi
  • Akio Tawa
  • Ichiro Tsukimoto
  • Masahiro Tsuchida
  • Akira Morimoto
  • Hiromasa Yabe
  • Keizo Horibe
  • Ryoji Hanada
  • Masue Imaizumi
  • Yasuhide Hayashi
  • Kazuko Hamamoto
  • Ryoji Kobayashi
  • Kazuko Kudo
  • Akira Shimada
  • Takako Miyamura
  • Hiroshi Moritake
  • Daisuke Tomizawa
  • Takashi Taga
  • Souichi Adachi
Original Article


The outcomes of children with relapsed acute myeloid leukemia (AML) are known to be poor, but remain obscure. We retrospectively analyzed 71 patients who had relapsed following first-line treatment under the AML99 protocol. We investigated the time and site of recurrence, response to re-induction therapy, and performance of hematopoietic stem cell transplantation (HSCT) in relapsed cases, and performed a multivariate analysis to identify prognostic factors. The 5-year overall-survival (OS) rate after relapse was 37 %. Of 71 patients, three died without any anti-leukemic therapy and two underwent allogeneic HSCT. The remaining 66 patients received re-induction chemotherapy, and 33 (50 %) achieved second CR (CR2). Twenty-two of 25 (88 %) late relapse patients and 11 of 41 (27 %) early relapse patients achieved CR2 (P < 0.001). Twenty-nine CR2 cases and 35 non-CR2 cases underwent allogeneic HSCT. The 5-year OS rate was significantly higher in patients who underwent HSCT in CR2 than those in non-CR2 (66 vs. 17 %, P < 0.000001). Multivariate analysis indicated that early relapse (P < 0.05) and the positivity of the FMS-like tyrosine kinase 3—internal tandem duplication (P < 0.05) were adverse prognostic factors for survival. In conclusion, the etiology of relapsed pediatric AML needs to be elucidated and effective chemotherapy should be administered to obtain CR2.


Acute myeloid leukemia (AML) Relapse Children Hematopoietic stem cell transplantation (HSCT) Second complete remission (CR2) 



The authors deeply appreciate the invaluable cooperation by the large number of physicians working at institutions affiliated to The Japanese Childhood AML Cooperative Study Group and The Japanese Pediatric Leukemia/Lymphoma Study Group. Research was supported by Grant-in-Aid for Cancer Research from the Ministry of Health, Labor, and Welfare of Japan.

Conflict of interest

The authors declare no conflict of financial interest.


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Copyright information

© The Japanese Society of Hematology 2014

Authors and Affiliations

  • Hideki Nakayama
    • 1
    Email author
  • Ken Tabuchi
    • 2
  • Akio Tawa
    • 3
  • Ichiro Tsukimoto
    • 4
  • Masahiro Tsuchida
    • 5
  • Akira Morimoto
    • 6
  • Hiromasa Yabe
    • 7
  • Keizo Horibe
    • 8
  • Ryoji Hanada
    • 9
  • Masue Imaizumi
    • 10
  • Yasuhide Hayashi
    • 11
  • Kazuko Hamamoto
    • 12
  • Ryoji Kobayashi
    • 13
  • Kazuko Kudo
    • 14
  • Akira Shimada
    • 15
  • Takako Miyamura
    • 16
  • Hiroshi Moritake
    • 17
  • Daisuke Tomizawa
    • 18
  • Takashi Taga
    • 19
  • Souichi Adachi
    • 20
  1. 1.Department of Pediatrics, National Hospital OrganizationFukuoka-Higashi Medical CenterKogaJapan
  2. 2.Department of PediatricsTokyo Metropolitan Komagome HospitalTokyoJapan
  3. 3.Department of Pediatrics, National Hospital OrganizationOsaka Medical CenterOsakaJapan
  4. 4.Saiseikai Kanagawa Eastern HospitalYokohamaJapan
  5. 5.Ibaraki Children’s HospitalMitoJapan
  6. 6.Department of PediatricsJichi Medical SchoolShimonoJapan
  7. 7.Department of PediatricsTokai University School of MedicineIseharaJapan
  8. 8.Clinical Research Department, National Hospital OrganizationNagoya Medical CenterNagoyaJapan
  9. 9.Department of Hematology/OncologySaitama Children’s Medical CenterSaitamaJapan
  10. 10.Department of Hematology and OncologyMiyagi Children’s HospitalSendaiJapan
  11. 11.Gunma Children’s Medical CenterMaebashiJapan
  12. 12.Department of PediatricsHiroshima Red Cross and Atomic Bomb Survivors HospitalHiroshimaJapan
  13. 13.Department of PediatricsHokuyuh HospitalSapporoJapan
  14. 14.Department of Hematology/OncologyShizuoka Children’s HospitalShizuokaJapan
  15. 15.Department of PediatricsOkayama University School of MedicineOkayamaJapan
  16. 16.Department of PediatricsOsaka University School of MedicineOsakaJapan
  17. 17.Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of MedicineUniversity of MiyazakiMiyazakiJapan
  18. 18.Department of PediatricsTokyo Medical and Dental UniversityTokyoJapan
  19. 19.Department of PediatricsShiga University of Medical ScienceShigaJapan
  20. 20.Human Health SciencesKyoto UniversityKyotoJapan

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