The prognostic significance of early treatment response in pediatric relapsed acute myeloid leukemia: Results of the international study relapsed AML 2001/01

Ursula Creutzig*, Martin Zimmermann, Michael N. Dworzak, Brenda Gibson, Rienk Tamminga, Jonas Abrahamsson, Shau Yin Ha, Henrik Hasle, Alexey Maschan, Yves Bertrand, Guy Leverger, Christine von Neuhoff, Bassem Razzouk, Carmelo Rizzari, Petr Smisek, Owen P. Smith, Batia Stark, Dirk Reinhardt, Gertjan L. Kaspers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

The prognostic significance of early response to treatment has not been reported in relapsed pediatric acute myeloid leukemia. In order to identify an early and easily applicable prognostic factor allowing subsequent treatment modifications, we assessed leukemic blast counts in the bone marrow by morphology on days 15 and 28 after first reinduction in 338 patients of the international Relapsed-AML2001/01 trial. Both day 15 and day 28 status was classified as good (≤20% leukemic blasts) in 77% of patients. The correlation between day 15 and 28 blast percentages was significant, but not strong (Spearman correlation coefficient = 0.49, P<0.001). Survival probability decreased in a stepwise fashion along with rising blast counts at day 28. Patients with bone marrow blast counts at this time-point of ≤5%, 6-10%, 11-20% and >20% had 4-year probabilities of survival of 52%±3% versus 36%±10% versus 21%±9% versus 14%±4%, respectively, P<0.0001; this trend was not seen for day 15 results. Multivariate analysis showed that early treatment response at day 28 had the strongest prognostic significance, superseding even time to relapse (< or ≥12 months). In conclusion, an early response to treatment, measured on day 28, is a strong and independent prognostic factor potentially useful for treatment stratification in pediatric relapsed acute myeloid leukemia.

Original languageEnglish
Pages (from-to)1472-1478
Number of pages7
JournalHaematologica
Volume99
Issue number9
DOIs
StatePublished - 1 Sep 2014
Externally publishedYes

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