Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol
Outcome of children with relapsed acute myeloid leukemia following initial therapy under the AML99 protocol
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DOI：
10.1007/s12185-014-1616-9
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发表时间：
2014-08-01
影响因子：
2.1
通讯作者：
Adachi, Souichi
中科院分区：
文献类型：
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作者：
Nakayama, Hideki;Tabuchi, Ken;Adachi, Souichi
众所周知，复发性急性髓系白血病 (AML) 儿童的预后较差，但仍不清楚。我们回顾性分析了 71 名根据 AML99 方案一线治疗后复发的患者。我们调查了复发病例的复发时间和部位、对再诱导治疗的反应以及造血干细胞移植（HSCT）的表现，并进行了多变量分析以确定预后因素。复发后 5 年总生存 (OS) 率为 37%。 71 名患者中，3 名患者在未接受任何抗白血病治疗的情况下死亡，2 名患者接受了同种异体 HSCT。其余 66 例患者接受再诱导化疗，其中 33 例（50%）达到第二次 CR（CR2）。 25 名晚期复发患者中的 22 名 (88%) 和 41 名早期复发患者中的 11 名 (27%) 达到 CR2 (P < 0.001)。 29例CR2病例和35例非CR2病例接受同种异体HSCT。 CR2 期接受 HSCT 的患者的 5 年 OS 率显着高于非 CR2 期患者（66% vs. 17%，P < 0.000001）。多变量分析表明，早期复发（P < 0.05）和FMS样酪氨酸激酶3内部串联重复阳性（P < 0.05）是生存的不良预后因素。总之，需要阐明复发性儿童 AML 的病因，并应进行有效的化疗以获得 CR2。
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.