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Development of treatment and clinical results in childhood acute myeloid leukemia in the Slovak Republic

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Abstract

Background

Acute myeloid leukemia (AML) in children is rare, and it is generally considered to be more resistant to chemotherapy than acute lymphoblastic leukemia. However, because of the gradual intensification of chemotherapy and better supportive care, outcomes have improved considerably over the past 20 years. The management of children with AML in the Slovak Republic was unified and centralized during the second half of the 1990s with the introduction of Berlin-Frankfurt-Munster (BFM) protocols. In 2000, the AML-BFM-1998 protocol was introduced, and data collection became centralized.

Methods and results

Between 2000 and 2009, 73 patients (f = 38, m = 35) were treated according to the AML-BFM 1998. Complete remission (CR) was achieved in 89 % of the patients. The 5-year event-free-survival (EFS) and overall survival rates were 47 ± 6 % and 52 ± 6 %, respectively. The cumulative incidence of relapse was 38 %. The early death (ED) rate and the death rate in CR were both 7 %. The prognosis of children with favorable cytogenetics (standard risk (SR) group) tended to be better than the high-risk group (all other patients; EFS 63 vs. 40 %, p = 0.15). This tendency was supported by a significantly lower cumulative incidence of relapse in the SR-group (p = 0.008 by the log-rank test).

Conclusion

Unified treatment protocols and centralized diagnostics improved the management of pediatric AML in the Slovak Republic and increased the overall survival rate to 52 % in the total group and 68 % in children with a favorable cytogenetics. The high relapse rate and treatment-related mortality will be reduced by improving diagnostics, disease control, and the management of treatment-related complications.

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Acknowledgments

We thank all the patients and families who participated in this trial, the physicians and nurses from all three hospitals and the cytomorphologists and cytogeneticists for their excellent input. We also thank Prof. Dirk Reinhardt from the AML-BFM Study Group in Hannover for his external diagnostic and treatment supervision and Prof. Michael Dworzak and Rosa Kornmüller from St. Anna Kinderspital in Vienna for their help with establishing our cytomorphologic central review. We also thank Martin Zimmermann for the survival and cumulative incidence plots.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, University Childrens’ Hospital, Commenius University, Limbova 1, 83340, Bratislava, Slovak Republic

    Alexandra Kolenova PhD, MD, Zuzana Subova MD, Martina Mikeskova MD, Stanislava Hederova MD, Dana Petrzalkova MD, Alica Chocholova MD, Sabina Sufliarska PhD, MD, Julia Horakova PhD, MD,  Jan Cap PhD, MD, Anna Foltinova PhD, MD & Daniela Sejnova PhD, MD

  2. Department of Pediatric Hematology and Oncology, University Childrens Hospital, Banská Bystrica, Slovak Republic

    Eva Bubanska MD, PhD

  3. Department of Pediatric Hematology and Oncology, University Childrens’ Hospital, Košice, Slovak Republic

    Irina Oravkinova MD

  4. Department of Genetic, National Cancer Institute, Bratislava, Slovak Republic

    Lucia Copakova MD

  5. Department of Genetic, National Cancer Institute, Bratislava, Slovak Republic

    Emilia Kaiserova PhD, MD

  6. Department of Laboratory Medicine, University Childrens Hospital, Bratislava, Slovak Republic

    Zuzana Laluhova Striezencova MD, MPH & Oksana Fabri MD

Authors
  1. Alexandra Kolenova PhD, MD
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  2. Eva Bubanska MD, PhD
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  3. Irina Oravkinova MD
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  4. Zuzana Subova MD
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  5. Martina Mikeskova MD
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  6. Stanislava Hederova MD
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  7. Dana Petrzalkova MD
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  8. Zuzana Laluhova Striezencova MD, MPH
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  9. Oksana Fabri MD
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  10. Lucia Copakova MD
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  11. Alica Chocholova MD
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  12. Sabina Sufliarska PhD, MD
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  13. Julia Horakova PhD, MD
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  14. Jan Cap PhD, MD
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  15. Anna Foltinova PhD, MD
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  16. Daniela Sejnova PhD, MD
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  17. Emilia Kaiserova PhD, MD
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Corresponding author

Correspondence to Alexandra Kolenova PhD, MD.

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Kolenova, A., Bubanska, E., Oravkinova, I. et al. Development of treatment and clinical results in childhood acute myeloid leukemia in the Slovak Republic. memo 6, 46–53 (2013). https://doi.org/10.1007/s12254-012-0052-x

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  • DOI: https://doi.org/10.1007/s12254-012-0052-x

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