A large-scale study of children with relapsed acute myeloid leukemia (AML) has found that intensive re-induction therapy followed by hematopoietic cell transplantation (HCT) in second complete remission (CR2) is the best available treatment for the majority of these patients.
The study population was 543 pediatric patients with AML receiving treatment in 5 Nordic countries. Five-year overall survival (OS) for the whole patient cohort was 39%, and 5-year OS was 43% for 190 relapsed patients who received re-induction therapy, regardless of type (chemotherapy or HCT).
Relapse occurred in 208 patients, and for 128 of these relapsed patients who underwent HCT as consolidation therapy, 5-year OS was 61%, compared with 18% survival (p<0.001) for 19 patients who received chemotherapy only.
A multivariate analysis identified the following independent favorable prognostic factors for survival:
- Late relapse (≥1 year from diagnosis)
- No HCT for patients in first remission
- Core binding factor AML
There was no significant difference in survival between children receiving matched unrelated donor grafts or matched family donor grafts.
The researchers concluded that intensive re-induction therapy followed by HCT in CR2 is the best available treatment for the majority of patients with relapsed pediatric AML.