TY  - JOUR
A1  - Rasche, Mareike
A1  - Steidel, Emma
A1  - Zimmermann, Martin
A1  - Bourquin, Jean-Pierre
A1  - Boztug, Heidrun
A1  - Janotova, Iveta
A1  - Kolb, E. Anders
A1  - Lehrnbecher, Thomas
A1  - Neuhoff, Nils von
A1  - Niktoreh, Naghmeh
A1  - Mühlegger, Nora
A1  - Sramkova, Lucie
A1  - Stary, Jan
A1  - Walter, Christiane
A1  - Creutzig, Ursula
A1  - Dworzak, Michael
A1  - Reinhardt, Dirk
T1  - Second relapse of pediatric patients with acute myeloid leukemia: a report on current treatment strategies and outcome of the AML-BFM study group
T2  - Cancers
N2  - Simple Summary: Children with acute myeloid leukemia (AML) experience high relapse rates of about 30%; still, survival rates following the first relapse are encouraging. Hence, it is critically important to examine the consequences of a second relapse; however, little is known about this subgroup of patients. This retrospective population-based analysis intends to describe response, survival and prognostic factors relevant for the survival of children with second relapse of AML. Treatment approaches include many different therapeutic regimens, including palliation and intensive treatment with curative intent (63% of the patients). Survival is poor; however, patients who respond to reinduction attempts can be rescued with subsequent hematopoietic stem cell transplantation. We deciphered risk factors, such as short time interval from first to second relapse below one year as being associated with a poor outcome. This analysis will help to improve future international treatment planning and patient care of children with advanced AML.
Abstract: Successful management of relapse is critical to improve outcomes of children with acute myeloid leukemia (AML). We evaluated response, survival and prognostic factors after a second relapse of AML. Among 1222 pediatric patients of the population-based AML-Berlin–Frankfurt–Munster (BFM) study group (2004 until 2017), 73 patients met the quality parameters for inclusion in this study. Central review of source documentation warranted the accuracy of reported data. Treatment approaches included palliation in 17 patients (23%), intensive therapy with curative intent (n = 46, 63%) and other regimens (n = 10). Twenty-five patients (35%) received hematopoietic stem cell transplantation (HSCT), 21 of whom (88%) had a prior HSCT. Survival was poor, with a five-year probability of overall survival (pOS) of 15 ± 4% and 31 ± 9% following HSCT (n = 25). Early second relapse (within one year after first relapse) was associated with dismal outcome (pOS 2 ± 2%, n = 44 vs. 33 ± 9%, n = 29; p < 0.0001). A third complete remission (CR) is required for survival: 31% (n = 14) of patients with intensive treatment achieved a third CR with a pOS of 36 ± 13%, while 28 patients (62%) were non-responders (pOS 7 ± 5%). In conclusion, survival is poor but possible, particularly after a late second relapse and an intensive chemotherapy followed by HSCT. This analysis provides a baseline for future treatment planning.
KW  - acute myeloid leukemia
KW  - relapse
KW  - childhood acute myeloid leukemia
KW  - pediatric patients
KW  - salvage therapy
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62154
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-621546
SN  - 2072-6694
N1  - This work was supported by the German Cancer Aid 50-2728, 110244. M.R. is supported by the Josepha und Charlotte von Siebold program.
VL  - 13
IS  - 4, art. 789
SP  - 1
EP  - 13
PB  - MDPI
CY  - Basel
ER  -