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4/2023
vol. 27
abstract:
Original paper
Characteristics and treatment results of refractory and relapsed acute myeloid leukaemia in paediatric patients treated in Polish Paediatric Leukaemia/Lymphoma Study Group institutions according to the Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012 and a review of novel treatment possibilities in paediatric acute myeloid leukaemia
Jolanta Skalska-Sadowska
1
,
Maryna Krawczuk-Rybak
5
,
Katarzyna Muszyńska-Rosłan
5
,
Elżbieta Adamkiewicz-Drożyńska
6
,
Lucyna Maciejka-Kapuscińska
6
,
Agnieszka Chodała-Grzywacz
7
,
Barbara Sikorska-Fic
11
,
Anna Dąbrowska-Pawliszyn
12
,
Agnieszka Mizia-Malarz
13
,
Irena Karpińska-Derda
16
,
Justyna Urbańska-Rakus
16
,
1.
Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznań, Poland
2.
University of Medical Sciences, Poznań, Poland
3.
Department of Pediatric Oncology and Hematology, University Children Hospital, Kraków, Poland
4.
Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Haematologu, Wrocław Medical University, Wrocław, Poland
5.
Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
6.
Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
7.
Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital, Kielce, Poland
8.
Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
9.
Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, Olsztyn, Poland
10.
Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
11.
Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University, Warsaw, Poland
12.
Department of Pediatric Hematology and Oncology, Medical University of Silesia, Katowice, Zabrze, Poland
13.
Medical University of Silesia, Katowice, Poland
14.
Department of Pediatric Oncohematology, Clinical Province Hospital, Rzeszów, Poland
15.
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
16.
Department of Pediatric Hematology and Oncology, Pediatric Center, Chorzów, Poland
17.
Department of Pediatrics, Oncology and Hematology, Medical University, Łódź, Poland
Contemp Oncol (Pozn) 2023; 27 (4): 249–254
Online publish date: 2024/02/12
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Introduction:
This study aimed to present the clinical features and results of treatment of patients diagnosed with refractory or relapsed acute myeloid leukaemia (AML) in Polish Paediatric Leukaemia/Lymphoma Study Group (PPL/LSG) institutions, treated in accordance with the Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012, as their first-line therapy.
Material and methods:
The outcome data of 10 patients with refractory AML (median age 9.5 years) and 30 with relapsed AML (median age 12 years) were analysed retrospectively. Re-induction was usually based on idarubicin, fludarabine, and cytarabine along with allogeneic haematopoietic stem cell transplant (allo-HSCT) in 5 patients with refractory AML and 7 relapsed AML children.
Results:
37.5% (3/8) of refractory AML patients achieved second complete remission second complete remission (CRII). One of ten patients (1/10; 10%) was alive and stayed in complete remission for 34 months after the allo-HSCT. The probability of 3-year event-free survival (pEFS) in this group was 0.125 ±0.11. In the group of relapsed AML patients, the CRII was achieved in 9 patients (34%), and the probability of survival was: pEFS = 0.24 ±0.08; probability overall survival (pOS) = 0.34 ±0.09, with significantly better results achieved in patients who underwent allo-HSCT (pOS = 0.54 ±0.14 vs. 0.08 ±0.08, p < 0.0001).
Conclusions:
The prognosis of refractory AML and the first AML recurrence in children who were first-line treated in PPL/LSG centres according to Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012 is poor. Failures of re-induction treatment particularly result from difficulties in achieving remission. Allogeneic HSCT improves prognosis in children with refractory and first recurrent AML, under the condition it is performed in complete remission. Novel therapeutic approaches are needed to increase the remission rate and improve the outcomes.
keywords:
children, acute myeloid leukaemia, relapse, refractory, novel therapies
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