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

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Abstract

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.

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Hospital Organization, Fukuoka-Higashi Medical Center, Chidori 1-1-1, Koga, Fukuoka, 811-3195, Japan

    Hideki Nakayama

  2. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Ken Tabuchi

  3. Department of Pediatrics, National Hospital Organization, Osaka Medical Center, Osaka, Japan

    Akio Tawa

  4. Saiseikai Kanagawa Eastern Hospital, Yokohama, Japan

    Ichiro Tsukimoto

  5. Ibaraki Children’s Hospital, Mito, Japan

    Masahiro Tsuchida

  6. Department of Pediatrics, Jichi Medical School, Shimono, Japan

    Akira Morimoto

  7. Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan

    Hiromasa Yabe

  8. Clinical Research Department, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan

    Keizo Horibe

  9. Department of Hematology/Oncology, Saitama Children’s Medical Center, Saitama, Japan

    Ryoji Hanada

  10. Department of Hematology and Oncology, Miyagi Children’s Hospital, Sendai, Japan

    Masue Imaizumi

  11. Gunma Children’s Medical Center, Maebashi, Japan

    Yasuhide Hayashi

  12. Department of Pediatrics, Hiroshima Red Cross and Atomic Bomb Survivors Hospital, Hiroshima, Japan

    Kazuko Hamamoto

  13. Department of Pediatrics, Hokuyuh Hospital, Sapporo, Japan

    Ryoji Kobayashi

  14. Department of Hematology/Oncology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Kazuko Kudo

  15. Department of Pediatrics, Okayama University School of Medicine, Okayama, Japan

    Akira Shimada

  16. Department of Pediatrics, Osaka University School of Medicine, Osaka, Japan

    Takako Miyamura

  17. Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Hiroshi Moritake

  18. Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan

    Daisuke Tomizawa

  19. Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan

    Takashi Taga

  20. Human Health Sciences, Kyoto University, Kyoto, Japan

    Souichi Adachi

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  1. Hideki Nakayama
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  2. Ken Tabuchi
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Correspondence to Hideki Nakayama.

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Nakayama, H., Tabuchi, K., Tawa, A. et al. Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol. Int J Hematol 100, 171–179 (2014). https://doi.org/10.1007/s12185-014-1616-9

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  • DOI: https://doi.org/10.1007/s12185-014-1616-9

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