Advertisement

Intensified Early Therapy for Childhood Acute Myeloid Leukemia: Pilot Studies of the AIEOP Cooperative Group

  • S. Amadori
  • A. M. Testi
  • M. L. Moleti
  • A. Pession
  • R. Rondelli
  • F. Mandelli
Conference paper
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 38)

Abstract

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.

Keywords

Acute Myeloid Leukemia Complete Remission Complete Remission Rate Pediatric Acute Myelogenous Leukemia Postremission Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Stevens RF, Hann IH, Wheatley K, Gray R (1992) Intensive chemotherapy with or without additional bone marrow transplantation in pediatric AML: progress report on the MRC AML 10 trial. Leukemia 6 (Suppl 2): 55–58PubMedGoogle Scholar
  2. 2.
    Woods WG, Kabrinsky N, Buckley J, Neudorf S, Sanders J, Miller L, Barnard D, Benjamin D, De Swarte J, Kalousek D, Shina D, Hammond GD, and Lange BJ (1993) Intensively timed induction therapy followed by autologous or allogeneic bone marrow transplantation for children with acute myeloid leukemia or myelodysplastic syndrome: a Childrens Cancer Group pilot study. J.Clin Oncol 11:1448–1457PubMedGoogle Scholar
  3. 3.
    Nesbit ME, Buckley JD, Feig SA, Anderson JR, Lampkin B, Bernstein ID, Kim TH, Piomelli S, Kersey JH, Coccia PF, O’Reilly RC, August C, Thomas ED, Hammond GD (1994) Chemotherapy for induction of remission of childhood acute myeloid leukemia followed by marrow transplantation of multiagent chemotherapy: a report from the Childrens Cancer Group. J.Clin Oncol 12: 127–135PubMedGoogle Scholar
  4. 4.
    Ritter J, Creutzig U, Schellong G (1992) Treatment results of three consecutive German childhood AML trials: BFM-78, -83, and -87 Leukemia 6 (Suppl 2): 59–62PubMedGoogle Scholar
  5. 5.
    Weinstein H, Ravindranath Y, Krischer J, Steuber P. Civin C, Gresik M, and Vietti T (1992) The impact of early intensive therapy on event-free survival (EFS) in children with acute myeloid leukemia (AML). Leukemia 6 (Suppl 2): 52–54PubMedGoogle Scholar
  6. 6.
    Amadori S, Ceci A, Comelli A, Madon E, Masera G, Nespoli L, Paolucci G, Zanesco L, Vegna ML, Moleti ML, Testi AM, and Mandelli F (1990) Therapy of childhood acute myelogenous leukemia: an update of the AIEOP/LAM 8204 study. In: Buchner Schellong Hiddeman Ritter (eds) Acute leukemias II. Springer-Verlag Berlin Heidelberg, pp 222–225 (Hematology and Blood transfusion, vol 33).CrossRefGoogle Scholar
  7. 7.
    Amadori S, Testi AM, Arico’M, Comelli A, Giuliano M, Madon E, Masera G, Rondelli R, Zanesco L, and Mandelli F (1993) Prospective comparitive study of bone marrow transplantation and postremission chemotherapy for childhood acute myelogenous leukemia. J Clin Oncol 11: 1046–1054.PubMedGoogle Scholar
  8. 8.
    Amadori S, Giona F, Giuliano M, Moleti ML, Pession A, Rolla M, Rondelli R, Testi AM, Mandelli F (1992) Therapeutic strategies for postremission treatment in childhood acute myeloid leukemia (AML). The AIEOP experience 1987-1991. Leukemia 6 (Suppl 2): 44–47PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • S. Amadori
    • 1
  • A. M. Testi
    • 1
  • M. L. Moleti
    • 1
  • A. Pession
    • 1
  • R. Rondelli
    • 1
  • F. Mandelli
    • 1
  1. 1.Hematology Department of Human BiopathologyUniversity “La Sapienza”RomeItaly

Personalised recommendations