The results of treatment in children with AML and initial hyperleucocytosis according to the AML-MM-2006 Protocol

Abstract

The prognostic role of HL in AML in children is a matter of a discussion. 185 patients were treated for AML in our center, 36 of 185 had HL (19.5%). The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. Median Le was 97 × 109 /l (50–428 ± 109 /l). Standard risk group were 4 pts, intermediate – 8, hight – 24. The most common variants were M4/M5 in FAB classification – 30 pts and genetic rearrangement – MLL in 15 of 36 pts. Thirty-five patients with HL received cytoreduction course and ADE. After that, all patients received ADE and 21 pts second part of induction – course HAM. Remission was achieved in 27 (75%) out of 36 pts. HSCT was performed in 23 pts. Thirteen out of 36 patients with HL died: 4 (30%) – due to leukostasis complications. OS for HL group was 0.56 ± 0.09, for non-HL group was 0.75 ± 0.04, p = 0.005; EFS (HL) 0.42 ± 0.09, EFS (non-HL) 0.49 ± 0.04, p = 0.026. Also, differences in I CR achievement, median of remission length and death before remission between two groups were statistically significant (p = 0.036; p = 0.028; p = 0.021 respectively). OS and EFS in patients with M4/M5 with HL > 50 ± 109 /l were better than in patients all FAB with HL > 100 ± 109 /l, OS 0.71 ± 0.1 vs OS 0.43 ± 0.1 (p = 0.012); EFS 0.54 ± 0.1 vs EFS 0.29 ± 0.1 (p = 0.038) respectively. HL significantly worsens OS and EFS in children with AML.