Development of treatment and clinical results in childhood acute myeloid leukemia in the Slovak Republic
Background: Acute myeloid leukemia (AML) in children is rare, and it is generally considered to be more resistant to chemotherapy than acute lymphoblastic leukemia. However, because of the gradual intensification of chemotherapy and better supportive care, outcomes have improved considerably over the past 20 years. The management of children with AML in the Slovak Republic was unified and centralized during the second half of the 1990s with the introduction of Berlin-Frankfurt-Munster (BFM) protocols. In 2000, the AML-BFM-1998 protocol was introduced, and data collection became centralized.
Methods and results: Between 2000 and 2009, 73 patients (f = 38, m = 35) were treated according to the AML-BFM 1998. Complete remission (CR) was achieved in 89 % of the patients. The 5-year event-free-survival (EFS) and overall survival rates were 47 ± 6 % and 52 ± 6 %, respectively. The cumulative incidence of relapse was 38 %. The early death (ED) rate and the death rate in CR were both 7 %. The prognosis of children with favorable cytogenetics (standard risk (SR) group) tended to be better than the high-risk group (all other patients; EFS 63 vs. 40 %, p = 0.15). This tendency was supported by a significantly lower cumulative incidence of relapse in the SR-group (p = 0.008 by the log-rank test).
Conclusion: Unified treatment protocols and centralized diagnostics improved the management of pediatric AML in the Slovak Republic and increased the overall survival rate to 52 % in the total group and 68 % in children with a favorable cytogenetics. The high relapse rate and treatment-related mortality will be reduced by improving diagnostics, disease control, and the management of treatment-related complications.
Alexandra Kolenova, Eva Bubanska, Irina Oravkinova, Zuzana Subova, Martina Mikeskova, Stanislava Hederova, Dana Petrzalkova, Zuzana Laluhova Striezencova, Oksana Fabri, Lucia Copakova, Alica Chocholova, Sabina Sufliarska, Julia Horakova, Prof. Jan Cap, Anna Foltinova, Daniela Sejnova, Asso. Prof. Emilia Kaiserova, memo - Magazine of European Medical Oncology 1/2013