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Treatment strategies and long-term results in paediatric patients treated in four consecutive AML-BFM trials

Leukemia volume 19, pages 2030–2042 (2005)Cite this article

Abstract

A total of 1111 children with acute myeloblastic leukaemia (AML) were treated in four consecutive Berlin–Frankfurt–Münster (BFM) studies from 1978 to 1998. The first cooperative trial AML-BFM 78 established intensive chemotherapy with seven drugs, CNS irradiation and 2-year maintenance, achieving a long-term survival (overall survival (OS)) of 40%. Induction intensification in AML-BFM 83 resulted in significant improvement of disease-free survival (DFS). The risk of haemorrhage, especially in children with hyperleukocytosis, proved the high relevance of supportive care. In AML-BFM 87, the benefit of CNS irradiation in preventing CNS/systemic relapses was demonstrated. In AML-BFM 93, the introduction of idarubicin during first induction followed by intensification with HAM increased the 5-year EFS, DFS and OS to 50±2, 61±3 and 57±2%, respectively. Stem cell transplantation (SCT), as applied in high-risk patients with a matched related donor, did not significantly improve the outcome compared to chemotherapy alone. In spite of treatment intensification, the therapy-related death rate decreased from trial to trial, mainly during induction. The future aim is to reduce long-term sequelae, especially cardiotoxicity, by administration of less cardiotoxic drugs, and toxicity of SCT by risk-adapted indications. The AML-BFM studies performed in three European countries with >70 cooperating centres have significantly improved the outcome in AML children; nevertheless, increasing experience with these intensive treatment regimens is of fundamental importance to reduce fatal complications.

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Acknowledgements

This work is supported by Deutsche Krebshilfe e.v. Principal investigators of the AML-BFM trials in different countries are given in Supplementary Information.

Author information

Authors and Affiliations

  1. Department of Haematology, Oncology, University Children's Hospital, Münster, Germany

    U Creutzig, J Ritter, D Reinhardt, H Jürgens & G Schellong

  2. Department of Haematology, Oncology, University Children's Hospital, Hannover, Germany

    M Zimmermann & H Riehm

  3. Department of Haematology, Oncology, University Children's Hospital, Jena, Germany

    J Hermann

  4. Department of Haematology, Oncology, University Children's Hospital, Berlin, Germany

    G Henze

  5. Department of Haematology, Oncology, University Children's Hospital, Hamburg, Germany

    H Kabisch

  6. Department of Haematology, Oncology, University Children's Hospital, Giessen, Germany

    A Reiter

  7. Children's Cancer Research Institute and St Anna Kinderspital, Vienna, Austria

    H Gadner

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Correspondence to U Creutzig.

Additional information

This paper is dedicated to Christa Lausch, our valuable coworker in the AML-BFM Trial Centre from 1982-2003.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu).

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Creutzig, U., Zimmermann, M., Ritter, J. et al. Treatment strategies and long-term results in paediatric patients treated in four consecutive AML-BFM trials. Leukemia 19, 2030–2042 (2005). https://doi.org/10.1038/sj.leu.2403920

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