Characteristics and outcome of primary resistant disease in paediatric acute myeloid leukaemia

被引:3
作者
Karlsson, Lene [1 ]
Cheuk, Daniel [2 ,3 ]
De Moerloose, Barbara [4 ]
Hasle, Henrik [5 ]
Jahnukainen, Kirsi [6 ,7 ]
Juul-Dam, Kristian Lovvik [5 ]
Kaspers, Gertjan [8 ,9 ]
Kovalova, Zanna [10 ]
Lausen, Birgitte [11 ]
Nystrom, Ulrika Noren [12 ]
Palle, Josefine [13 ]
Pronk, Cornelis Jan [14 ]
Saks, Kadri [15 ]
Tierens, Anne
Zeller, Bernward
Abrahamsson, Jonas [1 ]
机构
[1] Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden
[2] Hong Kong Childrens Hosp, Dept Pediat & Adolescent Med, Hong Kong, Peoples R China
[3] Hong Kong Pediat Hematol & Oncol Study Grp HKPHOSG, Hong Kong, Peoples R China
[4] Ghent Univ Hosp, Dept Pediat Hematol Oncol, Ghent, Belgium
[5] Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark
[6] Univ Helsinki, New Childrens Hosp, Pediat Res Ctr, Helsinki, Finland
[7] Helsinki Univ Hosp, Helsinki, Finland
[8] Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands
[9] Vrije Univ Amsterdam, Emma Childrens Hosp, Amsterdam UMC, Pediat Oncol, Amsterdam, Netherlands
[10] Childrens Clin Univ Hosp, Dept Paediat Oncol Haematol, Dept Pathobiol & Lab Med, Riga, ON, Latvia
[11] Univ Copenhagen, Dept Pediat & Adolescent Med, Rigshosp, Copenhagen, Denmark
[12] Umea Univ, Dept Clin Sci, Pediat, Pediat Hematol & Oncol, Box 400, S-40530 Umea, Sweden
[13] Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden
[14] Skane Univ Hosp, Childhood Canc Ctr, Lund, Sweden
[15] SA Tallinna Lastehaigla, Dept Paediat, Tallinn, Estonia
关键词
acute myeloid leukaemia; paediatric; resistant disease; survival; CHILDREN; CHILDHOOD; THERAPY; FLT3/ITD; TRIAL;
D O I
10.1111/bjh.18685
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A significant proportion of events in paediatric acute myeloid leukaemia (AML) are caused by resistant disease (RD). We investigated clinical and biological characteristics in 66 patients with RD from 1013 children with AML registered and treated according to the NOPHO-AML 93, NOPHO-AML 2004, DB AML-01 and NOPHO-DBH AML 2012 protocols. Risk factors for RD were age10 years or older and a white-blood-cell count (WBC) of 100 x 10(9)/L or more at diagnosis. The five-year overall survival (OS) was 38% (95% confidence interval [CI]: 28%-52%). Of the 63 children that received salvage therapy with chemotherapy, 59% (N = 37) achieved complete remission (CR) with OS 57% (95% CI: 42%-75%) compared to 12% (95% CI: 4%-35%) for children that did not achieve CR. Giving more than two salvage chemotherapy courses did not increase CR rates. OS for all 43 patients receiving allogeneic haematopoietic stem cell transplantation (HSCT) was 49% (95% CI: 36%-66%). Those achieving CR and proceeding to HSCT had an OS of 56% (95% CI: 41%-77%, N = 30). This study showed that almost 40% of children with primary resistant AML can be cured with salvage therapy followed by HSCT. Children that did not achieve CR after two salvage courses with chemotherapy did not benefit from additional chemotherapy.
引用
收藏
页码:757 / 765
页数:9
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