Development of treatment and clinical results in childhood acute myeloid leukemia in Slovenia in the period from 1991 to 2010
Background: A review of treatment and survival of children with acute myeloid leukemia (AML) in Slovenia from 1991 to 2010.
Methods: We collected demographic data, information on the time, and course of treatment of patients with AML, which were classified in three risk groups and treated according to standard arm of BFM AML protocols 83, 93, 98, and 04. We assessed the rate of remission, event-free survival and overall survival, the incidence of relapse, the secondary neoplasms, secondary AML, the proportion of patients treated with hematopoietic stem cell transplantation (HSCT) and causes of death. The 2- and 5-year overall survival (5yOS) was estimated according to age group, risk group, the presence of remission, and the time of the treatment.
Results: There were 50 patients, 18 males (36 %) and 32 females (64 %) included in this study. Secondary AML was presented in four patients. Patients treated with HSCT were 18 (36 %), 9 of them in first remission. The 2-year overall survival (2yOS) was 63.7 ± 6.8 % and 5-year survival was 55.0 ± 7.2 %. Differences in survival between age groups (0–5 years, 6–10 years and more than 10 years) was not significant. All patients in standard risk group lived for more than 2 years, in high-risk group 2yOS was 56.7 ± 7.7 % (p = 0.05). Patients who were in remission before second treatment block had 2yOS 77.8 ± 7.4 % and 5yOS 63.8 ± 8.8 %, compared to the patients who were not in remission (2yOSand 5yOS 37.5 ± 12.1 %, p = 0.001). The 2yOS in patients treated with HSCT in first remission was 62 %. There were 17 patients (34 %) who had relapse of the disease, 23 (64 %) patients died, 14 (61 %) due to progression of the disease.
Conclusions: The results of treatment of AML in our center are comparable with other European centers. Survival was better in the standard risk group and in patients who were in remission before second treatment block. We observed a trend of improvement in survival in the time observed.