TY - JOUR
T1 - Survival following relapse in children with acute myeloid leukemia
T2 - A report from aml-bfm and cog
AU - Rasche, Mareike
AU - Zimmermann, Martin
AU - Steidel, Emma
AU - Alonzo, Todd
AU - Aplenc, Richard
AU - Bourquin, Jean Pierre
AU - Boztug, Heidrun
AU - Cooper, Todd
AU - Gamis, Alan S.
AU - Gerbing, Robert B.
AU - Janotova, Iveta
AU - Klusmann, Jan Henning
AU - Lehrnbecher, Thomas
AU - Mühlegger, Nora
AU - Neuhoff, Nils V.
AU - Niktoreh, Naghmeh
AU - Sramkova, Lucie
AU - Stary, Jan
AU - Waack, Katharina
AU - Walter, Christiane
AU - Creutzig, Ursula
AU - Dworzak, Michael
AU - Kaspers, Gertjan
AU - Kolb, Edward Anders
AU - Reinhardt, Dirk
N1 - Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/5/2
Y1 - 2021/5/2
N2 - Post-relapse therapy remains critical for survival in children with acute myeloid leukemia (AML). We evaluated survival, response and prognostic variables following relapse in independent cooperative group studies conducted by COG and the population-based AML-BFM study group. BFM included 197 patients who relapsed after closure of the last I-BFM relapse trial until 2017, while COG included 852 patients who relapsed on the last Phase 3 trials (AAML0531, AAML1031). Overall survival at 5 years (OS) was 42 ± 4% (BFM) and 35 ± 2% (COG). Initial high-risk features (BFM 32 ± 6%, COG 26 ± 4%) and short time to relapse (BFM 29 ± 4%, COG 25 ± 2%) predicted diminished survival. In the BFM dataset, there was no difference in OS for patients who had a complete remission with full hematopoietic recovery (CR) following post-relapse re-induction compared to those with partial neutrophil and platelet recovery (CRp and CRi) only (52 ± 7% vs. 63 ± 10%, p = 0.39). Among 90 patients alive at last follow-up, 87 had received a post-relapse hematopoietic stem cell transplant (HSCT). OS for patients with post-relapse HSCT was 54 ± 4%. In conclusion, initial high-risk features and early relapse remain prognostic. Response assessment with full hematopoietic recovery following initial relapse therapy does not predict survival. These data indicate the need for post-relapse risk stratification in future studies of relapse therapies.
AB - Post-relapse therapy remains critical for survival in children with acute myeloid leukemia (AML). We evaluated survival, response and prognostic variables following relapse in independent cooperative group studies conducted by COG and the population-based AML-BFM study group. BFM included 197 patients who relapsed after closure of the last I-BFM relapse trial until 2017, while COG included 852 patients who relapsed on the last Phase 3 trials (AAML0531, AAML1031). Overall survival at 5 years (OS) was 42 ± 4% (BFM) and 35 ± 2% (COG). Initial high-risk features (BFM 32 ± 6%, COG 26 ± 4%) and short time to relapse (BFM 29 ± 4%, COG 25 ± 2%) predicted diminished survival. In the BFM dataset, there was no difference in OS for patients who had a complete remission with full hematopoietic recovery (CR) following post-relapse re-induction compared to those with partial neutrophil and platelet recovery (CRp and CRi) only (52 ± 7% vs. 63 ± 10%, p = 0.39). Among 90 patients alive at last follow-up, 87 had received a post-relapse hematopoietic stem cell transplant (HSCT). OS for patients with post-relapse HSCT was 54 ± 4%. In conclusion, initial high-risk features and early relapse remain prognostic. Response assessment with full hematopoietic recovery following initial relapse therapy does not predict survival. These data indicate the need for post-relapse risk stratification in future studies of relapse therapies.
KW - Acute myeloid leukemia
KW - Childhood acute myeloid leukemia
KW - Pediatric
KW - Relapse
KW - Salvage therapy
UR - http://www.scopus.com/inward/record.url?scp=85105667905&partnerID=8YFLogxK
U2 - 10.3390/cancers13102336
DO - 10.3390/cancers13102336
M3 - Article
AN - SCOPUS:85105667905
VL - 13
JO - Cancers
JF - Cancers
IS - 10
M1 - 2336
ER -