Outcome of children treated for relapsed acute myeloid leukemia in Central America

Abstract

Children with relapsed AML in Central America rarely survive, so palliative strategies should be considered following relapse in this population. However, children with late relapse or with APML may have a prolonged period of remission with second treatment, and consideration of re-treatment may be appropriate.

Management of relapsed and refractory childhood acute promyelocytic leukaemia: recommendations from an international expert panel

“…A paediatric APL study reported that time from diagnosis to relapse of <18 months was significantly associated with worse EFS ( P = 0·001) and overall survival (OS) ( P = 0·002). However, the number of children in this study was too small ( n = 24) to draw strong/definitive conclusions (Marjerrison et al , ). A recent European Leukaemia Net registry of relapsed APL addressed the outcome of 155 patients (14 children) treated with ATO following the first relapse.…”

“…Several studies have identified prognostic factors in patients with relapsed APL who underwent salvage therapy with or without HSCT (Roman et al , ; Ramadan et al , ; Chakrabarty et al , ; Lou et al , ; Marjerrison et al , ; Lengfelder et al , ). However, most studies involved adults with very few subjects being <18 years of age (Chakrabarty et al , ; Marjerrison et al , ; Lengfelder et al , ). The most controversial issue is the definition of early and late relapse.…”

“…Prognostic factors in relapsed APL arise from adult (Roman et al , ; Ramadan et al , ; Chakrabarty et al , ; Lou et al , ; Lengfelder et al , ) and more limited paediatric literature (Marjerrison et al , ) (Table ): time to relapse <18 months from diagnosis, prior ATO therapy and failure to clear PML‐RARA transcripts. These factors will be used to predict the risk of further relapse (Table ) and consequently to guide which children can be treated with further differentiating agents and CT alone, and who would benefit from either auto‐ or allo‐HSCT.…”

HIF-1α inhibition by 2-methoxyestradiol induces cell death via activation of the mitochondrial apoptotic pathway in acute myeloid leukemia

“…2 Although some patients can achieve complete remission, many eventually relapse. 3 Recently, studies have suggested that chemotherapy resistance is the main reason for the failure of chemotherapy and disease recurrence for AML patients. [4][5] The bone marrow microenvironment plays a critical role in the development, progression, and relapse of AML.…”

Outcome of relapsed/refractory acute promyelocytic leukaemia in children, adolescents and young adult patients — a 25‐year Italian experience

“…12 The molecular disease status at transplant has emerged as an important prognostic variable. [13][14][15][16] The retrospective analysis from the European Acute Promyelocytic Leukemia Group comparing autologous and allogeneic HSCT in relapsed adult APL demonstrated the efficacy of autologous HSCT performed in molecular CR. 17 In the recent analysis of relapsed APL treated upfront with ATO and salvaged with ATO-based regimens, an autologous HSCT was offered in second molecular CR; the 5 year OS and EFS were 90Á3% and 87Á1% respectively.…”