Development of treatment and clinical results in childhood acute myeloid leukemia in the Czech Republic
Purpose: Treatment of childhood acute myeloid leukemia (AML) was unified in the year 1993 according to acute myeloid leukemia-Berlin–Frankfurt–Munster (AML-BFM) protocols in the Czech Republic. We evaluated data on clinical and therapeutic results in children with AML treated in three subsequent trials, comparing two periods, June 1993 to February 2004 (AML-BFM 93 and 98) vs. March 2004 to December 2009 (AML-BFM 2004 trial).
Patients and methods: Data of 182 eligible patients were analyzed, 125 in AML-BFM 93 and 98 trials, and 57 in AML-BFM 2004 trial enrolled prior to December 2009. Down syndrome patients were excluded from analysis.
Results: In studies AML-BFM 93 and 98, 79.2 % of 125 patients achieved complete remission (CR), 19 patients (15.2 %) suffered from early death, 7 (5.6 %) were nonresponders, 33 (33.3 %) relapsed, 12 (12.1 %) died in CR, and 2 patients (2.0 %) developed secondary malignancy. The estimated probability of event-free survival (pEFS) at 5 years was 41.6 %, the overall survival (OS) at 5 years was 46.4 %. In AML-BFM 2004 trial, 93 % of 57 patients attained CR, 3 patients (5.2 %) suffered from early death, 1 (1.8 %) was nonresponder, 16 (30.2 %) relapsed, 2 (3.8 %) died in CR, and 2 patients (3.5 %) developed secondary malignancy. The estimated pEFS at 5 years was 56.1 %, 5-years overall survival (5y-OS) was 73.7 %.
Conclusion: Gradual improvement of CR rate and OS together with decreasing incidence of toxic deaths in AML patients were achieved because of gain of experience with very intensive modern treatment centralized in a limited number of institutions.
Lucie Sramkova, Jaroslav Sterba, Hana Hrstkova, Vladimir Mihal, Bohumir Blazek, Pavel Timr, Zdena Cerna, Daniela Prochazkova, Jiri Hak, Petr Sedlacek, Iveta Janotova, Elena Vodickova, Zuzana Zemanova, Marie Jarosova, Alexandra Oltova, Katerina Zdrahalova, Ondrej Hrusak, Ester Mejstrikova, Jiri Schwarz, Jan Zuna, Jan Trka, Jan Stary, memo - Magazine of European Medical Oncology 1/2013