Akute myeloische Leukämie bei Kindern: Ergebnisse der kooperativen Therapiestudie BFM-78 nach 3 3/4 Jahren*

Abstract

Between December, 1978, and October, 1982, 151 children with acute myelogenous leukemia from 30 pediatric clinics entered the cooperative study. The treatment consisted of a 10-week intensive induction therapy and a subsequent maintenance therapy, which is terminated for children in complete continuous remission after 2 years. The induction treatment during the first 4 weeks consisted of a combination of prednisone, 6-thioguanine (TG), vincristine, adriamycin (ADR) and cytosine-arabinoside (ARA-C). In the following 4 weeks i.v. cyclophosphamide, i.th. methotrexate and prophylactic cranial irradiation were administered in addition to TG, ARA-C and ADR. 119 of the 151 patients (79%) achieved complete remission. 13 children (9%) died of early hemorrhages, 2 of them before onset of therapy. 5 patients died initially of other complications, another 6 after remission has been achieved. 13 children did not respond or responded poorly to the induction therapy. So far, 40 relapses occurred, mainly in the bone marrow. In 6 relapses the central nervous system was involved. The probability for a continuous complete remission for the total group is 0.41 +/- 0.05 (life table analysis) and for the total group 0.56 +/- 0.06 after 45 months. The corresponding probability for survival after 46 months are 0.43 +/- 0.06 for the remission group. The risk for occurrence of early fatal hemorrhages was higher in children with acute monocytic leukemia than in the other morphological subtypes. An initial leukocyte count of more than 100,000/microliters was found significantly more often in patients who did not achieve remission (early deaths and nonresponders) than in children of the remission group. So far, no factors could be identified which influence the risk for relapse. The present results of the study allow the conclusion, that with the applied treatment strategy it is possible to achieve not only in a high portion of children with AML remission but also to improve the chances for long-time remission and perhaps cure.

Therapeutic modalities for central nervous system involvement by granulocytic sarcoma (chloroma) in children with acute nonlymphocytic leukemia

“…The tumor develops at various stages of nonlymphocytic leukemia with a reported frequency ranging from 2.9 to 6.8% [2,9,12]. Major progress in the treatment of ANLL has occured during the past decade; more than 25% of children with ANLL have been in initial complete remission for two years with intensive therapy [13][14][15][16]. Thus, the actual frequency of granulocytic sarcoma is probably higher than reports suggest.…”

Aclacinomycin-A in the Induction Treatment of Childhood AML

“…1 or 2 courses of induction chemotherapy (II and 12) have been used to achieve early complete remission (CR) (less than 5% blast cells in bone marrow smears). The facultative course 12, the consolidation as well as the maintenance treatment were iden tical with the complete study protocol currently used by the BFM group (AML-BFM-83), which was derived from the AML-BFM-78 protocol just by adding the course of induction chemotherapy 12 [1], The induction chemotherapy consisted of ARA-C 100 mg/m2 i. v. as a continuous infusion (i. v. Cl) on days 1 and 2, followed by 100 mg/m2 12-hourly i.v. as a short infusion (i.v.…”

Moderne Behandlungsstrategien bei Kopf-Halsgeschwülsten im Kindes- und Jugendalter - eine Übersicht*

“…Nebenwirkungen und einer Mortalität bis zu S % während der Therapie infolge Blutungen und Infektionen (3,5,6,10,12,14,16,26,32,33) hat die muitimodaie Behandlung der Malignorne inclusive Kopf-Halsgeschwulste irn Kindesalter in den letzten Jahren wesentliche Fortschritte hinsichtlich der tumorfreien Uberlebenszeit ergeben (Tab. 4).…”