Induction chemotherapy followed by allogeneic bone marrow transplantation or aggressive consolidation chemotherapy in childhood acute myeloblastic leukemia: A prospective study from the French Society of Pediatric Hematology and Immunology (SHIP)

Gautier, Michel; Baruchel, André; Tabone, Marie‐Dominique; Nelken, Brigitte; Leblanc, Thierry; Thuret, Isabelle; Bordigoni, Pierre; Bergeron, Christophe; Espérou-Bourdeau, H; Pérel, Yves; Vannier, Jean‐Pierre; Lumley, L. De; Dommergues, J.P.; Lamagnere, J. P.; Couillaud, Gérard; Auvrignon, Anne; Schaison, G; Leverger, Guy

doi:10.1007/s00282-996-0169-7

Cited by 30 publications

(39 citation statements)

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“…The role of myeloablative therapy followed by allo-BMT from an HLA-identical sibling for improving disease-free survival (DFS) in children with AML in CR1 was examined in this study. 2 The results are now available on a long term.…”

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confidence: 87%

Treatment of childhood acute myeloblastic leukemia: dose intensification improves outcome and maintenance therapy is of no benefit – multicenter studies of the French LAME (Leucémie Aiguë Myéloblastique Enfant) Cooperative Group

Pérel¹,

Auvrignon²,

Leblanc³

et al. 2005

Leukemia

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From 1989 to 1998, 341 children were included in the French multicentric LAME (Leucé mie Aiguë Myé loblastique Enfant) trials. A total of 309 children were registered in the LAME 89/91 protocol. This intensive regimen included an induction phase (mitoxantrone plus cytarabine), two consolidation courses, one containing timed-sequential high-dose cytarabine, asparaginase and amsacrine; 276 (90%) achieved a CR. The 5-year overall survival (OS) and event-free survival (EFS) were 6074 and 4874%, respectively. From 1997, timed-sequencing of the LAME SP induction chemotherapy led to an unacceptable frequency of consolidation delay; future improvements are unlikely to come from further increases in intensity. The role of allogenic bone-marrow transplantation from an HLA-identical sibling in CR1 was examined. The disease-free survival (DFS) was 5274% for non-allografted patients and 5777% for allografted patients (P ¼ NS); a better OS for allografted patients was shown and could be related either to allo-BMT early in CR1 or to a second allo-BMT in CR2. For the complete responders after consolidation therapy, the 5-year OS was significantly better in patients randomized for no maintenance therapy (MTÀ) than in patients randomized for MT (77.678 vs 5978%; P ¼ 0.05), while the 5-year DFS was not significantly different. Exposure to low-dose MT might contribute to clinical drug resistance and treatment failure in relapsing patients.

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confidence: 87%

Treatment of childhood acute myeloblastic leukemia: dose intensification improves outcome and maintenance therapy is of no benefit – multicenter studies of the French LAME (Leucémie Aiguë Myéloblastique Enfant) Cooperative Group

Pérel¹,

Auvrignon²,

Leblanc³

et al. 2005

Leukemia

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“…Patients were classified into three cytogenetics groups as good risk [t(15;17), inv (16) All patients had received a 'cytarabine-anthracycline' based induction regimen according to the ongoing protocols in use during the different time periods. 13,[20][21][22] Those less than 20 years old were more likely to be transplanted in first CR than the others (92 vs 75%, P ¼ 0.03). Patients transplanted in first CR received intermediate or high-dose cytarabine (HiDAC) less frequently (16% in the CR1 group vs 67% in the CR2 group, Po0.001).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…[10][11][12] Finally, age is also a determinant in the indication for allogeneic SCT. 3,13 Constant improvements in the management of transplanted patients have resulted in increasing number of long-term survivors following allogeneic SCT. 14,15 However, the mortality rate of these long-term survivors is still higher than that of an age-matched population.…”

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confidence: 99%

Allogeneic bone marrow transplantation for acute myeloblastic leukaemia in remission: risk factors for long-term morbidity and mortality

Robin

Guardiola

Dombret

et al. 2003

Bone Marrow Transplant

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Summary:In this single-centre retrospective study, we analysed risk factors for nonrelapse long-term morbidity and mortality in patients with acute myeloblastic leukaemia (AML) who had undergone allogeneic transplantation. A total of 112 patients with de novo AML in first complete remission (CR1), n ¼ 90 or second complete remission (CR2, n ¼ 22) who received un-manipulated bone marrow grafts from human leukocyte antigen identical siblings between January 1985 and August 2000 were included. Of these, 97 patients alive and disease-free for at least 100 days after transplant were selected for the purpose of this longterm analysis. The use of an intensified conditioning regimen, Gram-negative bacteriaemia before transplantation, year of transplantation and number of pretransplant chemotherapy courses for patients in CR1 significantly affected the 7-year event-free survival which was 57%. 7-year transplant-related mortality TRM was 22%. Significant predictors for TRM were: bacterial infections before transplantation, major ABO blood group incompatibility, late severe bacterial infections, and chronic (graft-versus-host disease) GvHD. Predictive factors for late severe bacterial infections were infections before transplant, total body irradiation and GvHD. Incidence and risk factors for other late events including, chronic GvHD, late infections, osteonecrosis, cataract, endocrinecardiac-and lung-complications, cancer and performance status at last follow-up were also studied. The analysis strongly suggests that the combination of pretransplant factors such as chemotherapy and conditioning, and post transplant factors such as chronic GvHD had a major impact on late nonrelapse morbidity and mortality.

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“…8 Survival rates as high as 72% have been reported for children transplanted in CR1. 9 For children with AML beyond CR1, HSCT may be the only curative option. However, the clinical outcome for children transplanted in CR2 is not well defined, as studies published to date report data of these patients combined with other childhood diseases or with adult patients.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the outcomes of children with acute myelogenous leukemia in either first or second complete remission (CR1 vs CR2) following allogeneic hematopoietic stem cell transplantation at a single transplant center

Gassas

Ishaqi

Afzal

et al. 2008

Bone Marrow Transplant

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We reviewed 70 consecutive children with AML who received hematopoietic stem cell transplantation (HSCT) in our institution between 1994 and 2005. Forty-seven children were transplanted in CR1 and 23 were transplanted in CR2. BU/CY was the most common pretransplant conditioning regimen for CR1 patients and a TBI-based conditioning regimen was the most common regimen for CR2 patients. Most patients transplanted in CR1 (81%) received related donor HSCT, whereas most of the CR2 patients (74%) received unrelated donor HSCT. Expectedly, there was a significant increase in acute GVHD incidence in CR2 patients (40 vs 25% for grades I-II and 30 vs 10% for grades III-IV; P ¼ 0.02) and a significant increase in transplant-related mortality (38 vs 11%; P ¼ 0.01). Although the difference between 3-year EFS for CR1 and CR2 was not statistically significant, there was a significantly superior 3-year overall survival for CR1 patients (74 vs 51%; P ¼ 0.05). Children with relapsed AML who achieve and maintain remission until HSCT, have a reasonable survival, but the outcome of children receiving HSCT in CR1 remains superior.

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Induction chemotherapy followed by allogeneic bone marrow transplantation or aggressive consolidation chemotherapy in childhood acute myeloblastic leukemia: A prospective study from the French Society of Pediatric Hematology and Immunology (SHIP)

Cited by 30 publications

References 0 publications

Treatment of childhood acute myeloblastic leukemia: dose intensification improves outcome and maintenance therapy is of no benefit – multicenter studies of the French LAME (Leucémie Aiguë Myéloblastique Enfant) Cooperative Group

Treatment of childhood acute myeloblastic leukemia: dose intensification improves outcome and maintenance therapy is of no benefit – multicenter studies of the French LAME (Leucémie Aiguë Myéloblastique Enfant) Cooperative Group

Allogeneic bone marrow transplantation for acute myeloblastic leukaemia in remission: risk factors for long-term morbidity and mortality

A comparison of the outcomes of children with acute myelogenous leukemia in either first or second complete remission (CR1 vs CR2) following allogeneic hematopoietic stem cell transplantation at a single transplant center

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