TY - JOUR
T1 - The prognostic significance of early treatment response in pediatric relapsed acute myeloid leukemia
T2 - Results of the international study relapsed AML 2001/01
AU - Creutzig, Ursula
AU - Zimmermann, Martin
AU - Dworzak, Michael N.
AU - Gibson, Brenda
AU - Tamminga, Rienk
AU - Abrahamsson, Jonas
AU - Ha, Shau Yin
AU - Hasle, Henrik
AU - Maschan, Alexey
AU - Bertrand, Yves
AU - Leverger, Guy
AU - von Neuhoff, Christine
AU - Razzouk, Bassem
AU - Rizzari, Carmelo
AU - Smisek, Petr
AU - Smith, Owen P.
AU - Stark, Batia
AU - Reinhardt, Dirk
AU - Kaspers, Gertjan L.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84906071153&partnerID=8YFLogxK
U2 - 10.3324/haematol.2014.104182
DO - 10.3324/haematol.2014.104182
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AN - SCOPUS:84906071153
SN - 0390-6078
VL - 99
SP - 1472
EP - 1478
JO - Haematologica
JF - Haematologica
IS - 9
ER -
