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Outcomes of intensification of induction chemotherapy for children with highârisk acute myeloid leukemia: A report from the Children's Oncology Group
- Source :
- Pediatr Blood Cancer
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- BACKGROUND: High-risk pediatric acute myeloid leukemia confers a poor prognosis, and alternative strategies are needed to improve outcomes. We hypothesized that intensifying induction on the AAML1031 clinical trial would improve outcomes compared to the predecessor trial AAML0531. METHODS: Patients on AAML0531 received cytarabine (1600 mg/m(2))/daunorubicin (150 mg/m(2))/etoposide (ADE) for induction II and patients on AAML1031 received mitoxantrone (48 mg/m(2))/cytarabine (8000 mg/m(2)) (MA). Stem cell transplant (SCT) conditioning included busulfan/cyclophosphamide on AAML0531, whereas AAML1031 used busulfan/fludarabine and liberalized donor eligibility. Patients were included in this analysis if they met high-risk criteria common to the two trials by cytogenics or poor disease response after induction I ADE. RESULTS: MA provided no benefit over ADE at: induction II response (complete response [CR]: 64% vs. 62%, p = .87; measurable residual disease [MRD]+: 57% vs. 46%, p = .34); or intensification I response (CR: 79% vs. 94%, p = .27; MRD+: 27% vs. 20%, p = 1.0). When considered with altered SCT approach, MA did not improve 5-year disease-free survival (24% ± 9% vs. 18% ± 15%, p = .63) or 5-year overall survival (35% ± 10% vs. 38% ± 18%, p = .66). MA was associated with slower neutrophil recovery (median 34 vs. 27 days, p = .007) and platelet recovery (median 29 vs. 24.5 days, p = .04) and longer hospital stay (32 vs. 28 days, p = .01) during induction II. CONCLUSION: Intensification of induction II did not improve treatment response or survival, but did increase toxicity and resource utilization. Alternative strategies are urgently needed to improve outcomes for pediatric patients with high-risk acute myeloid leukemia (trials registered at clinicaltrials.gov NCT01371981, NCT00372593).
- Subjects :
- Oncology
medicine.medical_specialty
Neoplasm, Residual
Cyclophosphamide
Disease-Free Survival
Article
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Child
Busulfan
Clinical Trials as Topic
Mitoxantrone
Acute leukemia
business.industry
Cytarabine
Myeloid leukemia
Induction chemotherapy
Induction Chemotherapy
Hematology
Fludarabine
Leukemia, Myeloid, Acute
Treatment Outcome
Pediatrics, Perinatology and Child Health
business
medicine.drug
Subjects
Details
- ISSN :
- 15455017 and 15455009
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- Pediatric Blood & Cancer
- Accession number :
- edsair.doi.dedup.....8517538cb9adcbdcec3a341339a9a8e7