Intensified Early Therapy for Childhood Acute Myeloid Leukemia: Pilot Studies of the AIEOP Cooperative Group
The efficacy and feasibility of two intensive three-drug (idarubicin, cytarabine, etoposide) induction courses were tested in two consecutive AIEOP pilot studies (LAM 92P, LAM 93P) for the treatment of acute myeloid leukemia (AML) in children. From April 1992 to March 1993, 20 patients aged <17 years from seven AIEOP centers entered study LAM 92P. Of the 19 evaluable patients, one died during induction (5%), three were resistant (16%), and 15 achieved complete remission (CR; 79%). Thirteen of the 15 responders completed the therapeutic program, including allogeneic bone marrow transplantation (BMT) in four and high-dose cytarabine (HiDAC) intensive postremission therapy in nine. One patient died in CR, five had recurrent disease, and seven remain in continuous CR (CCR) with a median follow up of 21 months.
In April 1993 a new pilot study (LAM 93P) was activated with the following main changes: exclusion of French-American-British classification (FAB) M3 and M3v; autologous BMT (ABMT) as postremission therapy. As of December 1994, 49 children were enrolled from 19 AIEOP centers. CR was achieved in 40 patients (82%). Seven children (14%) died during induction; two (4%) were resistant. Of the 34 responding patients evaluable for the follow up (six too early), four died in CR and four had early relapse (<2 months). Twenty-six children were submitted to transplant (15 ABMT, 11 BMT). One of them died in CR and six relapsed. Nineteen children are alive in CCR, with a median follow up of 6.5 months. Results suggest that aggressive induction treatment was highly effective in children with AML, but associated with severe toxicity and mortality. HiDAC and ABMT postremission therapies were feasible after such intensive induction.
KeywordsAcute Myeloid Leukemia Complete Remission Complete Remission Rate Pediatric Acute Myelogenous Leukemia Postremission Therapy
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