Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia

Abstract

Longer neutrophil recovery time after the first induction course was associated with grade 3-4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.

Predisposition to prolonged neutropenia after chemotherapy for paediatric acute myeloid leukaemia is associated with better prognosis in the Japanese Paediatric Leukaemia/Lymphoma Study Group AML‐05 study

“…Additionally, HR patients with prolonged neutropenia were more likely to have a higher pOS ( P = 0·0739). Previous reports did not include this subgroup in their analysis 7,8 . Mechanistically, several factors can modulate the duration of neutropenia in AML patients.…”

“…Previous reports did not include this subgroup in their analysis. 7,8 Mechanistically, several factors can modulate the duration of neutropenia in AML patients. The duration of neutropenia was reduced by G-CSF treatment, 12 but the outcome did not change in this study.…”

“…This aspect may explain a previous report which showed an association between a longer neutrophil recovery time after the first induction and relapse. 7 Due to this reason, we excluded non-CR patients after IND1 from the current analysis.…”

“…This would also mean that myelosuppression could be indicative of outcome and not directly responsible for it. However, there are discrepancies regarding the role of myelosuppression in the outcome in AML patients 7,8 and we therefore analysed the association between the duration of neutropenia (indicative of the degree of myelosuppression) and prognosis in our Japanese Paediatric Leukaemia/Lymphoma Study Group (JPLSG) AML-05 cohort.…”

Use of granulocyte colony‐stimulating factor and risk of relapse in pediatric patients treated for acute myeloid leukemia according to NOPHO‐AML 2004 and DB AML‐01

“…Infection was the most common indication for G‐CSF administration (Table ), which is compatible with the fact that the frequency of severe infections was high for patients treated according to NOPHO‐AML 2004. 7 We have previously shown that AIET and HA 1 M were the most toxic courses and neutrophil recovery time was longer after AIET, FLA‐Dx, and HA 1 M, which corresponds well with G‐CSF being administered more frequently after these courses. More patients treated according to NOPHO‐AML 2004 compared to patients treated according to DB AML‐01 had received G‐CSF (39 vs 23%), which could be due to DB AML‐01 being less toxic, but the two groups also differ in median diagnostic year and institutional practices.…”