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Response-Guided Induction Therapy in Pediatric Acute Myeloid Leukemia With Excellent Remission Rate.

Abrahamsson, Jonas; Forestier, Erik; Heldrup, Jesper LU ; Jahnukainen, Kirsi; Jónsson, Olafur G; Lausen, Birgitte; Palle, Josefine; Zeller, Bernward and Hasle, Henrik (2011) In Journal of Clinical Oncology 29. p.310-315
Abstract
PURPOSE To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course. PATIENTS AND METHODS All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (≥ 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine,... (More)
PURPOSE To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course. PATIENTS AND METHODS All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (≥ 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine, cytarabine, and granulocyte colony-stimulating factor. Poor responders received allogeneic stem-cell transplantation (SCT) as consolidation. Results Seventy-four percent of patients had good response, 17% had intermediate response, and 7% had poor response after the first course. The overall remission frequency was 97.4%, with 92% in remission after the second course. The rate of induction death was 1.3%. Patients with an intermediate response had a lower event-free survival of 35% compared with good (61%) and poor responders (82%). CONCLUSION The NOPHO-AML 2004 induction strategy gives an excellent remission rate with low toxic mortality in an unselected population. Outcome is worse in patients with intermediate response but may be improved by intensifying consolidation in this group using SCT. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Oncology
volume
29
pages
310 - 315
publisher
American Society of Clinical Oncology
external identifiers
  • wos:000286319000021
  • pmid:21149663
  • scopus:79951972587
ISSN
1527-7755
DOI
10.1200/JCO.2010.30.6829
language
English
LU publication?
yes
id
e47b0f5c-dafa-47d3-b28e-063fd1f07fc9 (old id 1756500)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21149663?dopt=Abstract
date added to LUP
2011-01-03 15:17:56
date last changed
2017-11-19 04:19:07
@article{e47b0f5c-dafa-47d3-b28e-063fd1f07fc9,
  abstract     = {PURPOSE To evaluate the early treatment response in children with acute myeloid leukemia (AML) using a response-guided induction strategy that includes idarubicin in the first course. PATIENTS AND METHODS All Nordic children with AML younger than 15 years (n = 151) were treated on the Nordic Society for Pediatric Hematology and Oncology (NOPHO) AML 2004 protocol. After the first course of idarubicin, cytarabine, etoposide, and 6-thioguanin, patients with good response were allowed hematologic recovery before the second course, whereas patients with a poor (≥ 15% blasts) or intermediate (5% to 14.9% blasts) were recommended to proceed immediately with therapy. Patients not in remission after the second course received fludarabine, cytarabine, and granulocyte colony-stimulating factor. Poor responders received allogeneic stem-cell transplantation (SCT) as consolidation. Results Seventy-four percent of patients had good response, 17% had intermediate response, and 7% had poor response after the first course. The overall remission frequency was 97.4%, with 92% in remission after the second course. The rate of induction death was 1.3%. Patients with an intermediate response had a lower event-free survival of 35% compared with good (61%) and poor responders (82%). CONCLUSION The NOPHO-AML 2004 induction strategy gives an excellent remission rate with low toxic mortality in an unselected population. Outcome is worse in patients with intermediate response but may be improved by intensifying consolidation in this group using SCT.},
  author       = {Abrahamsson, Jonas and Forestier, Erik and Heldrup, Jesper and Jahnukainen, Kirsi and Jónsson, Olafur G and Lausen, Birgitte and Palle, Josefine and Zeller, Bernward and Hasle, Henrik},
  issn         = {1527-7755},
  language     = {eng},
  pages        = {310--315},
  publisher    = {American Society of Clinical Oncology},
  series       = {Journal of Clinical Oncology},
  title        = {Response-Guided Induction Therapy in Pediatric Acute Myeloid Leukemia With Excellent Remission Rate.},
  url          = {http://dx.doi.org/10.1200/JCO.2010.30.6829},
  volume       = {29},
  year         = {2011},
}