ABSTRACT
Background:
Pediatric
acute myeloid leukemia (AML) has poor
prognosis and high rate of
relapse and
mortality, and exploration of new
treatment options is still critically needed.
Objectives:
To summarize the outcome of our new
treatment strategies for pediatric AML, which is characterized by dual induction and
acute lymphoblastic leukemia (ALL)
elements consolidation.
Design:
Retrospective, single-
arm study.
Methods:
From July 2012 to December 2019, an intensive
chemotherapy protocol was used for newly diagnosed
children with AML, which contains dual induction, three
courses of consolidations based on high-
dose cytarabine, and two
courses of consolidations composed of high-
dose methotrexate,
vincristine,
asparaginase, and
mercaptopurine (ALL-like
elements). Blasts were monitored by
bone marrow smears at intervals, and two
lumbar punctures were performed during
chemotherapy. We retrospectively analyzed the
efficacy and
safety of this study. The last follow-up was on 26 May 2023.
Results:
A total of 70 pediatric AMLs were included. The median age at
diagnosis was 6.7 (0.5-16.0) years. The median initial WBC count was 23.74 × 109/L, 11 of whom ⩾100 × 109/L. After dual induction, there were 62 cases of complete remission (CR), 5 cases of partial remission, and 3 cases of nonremission. The CR rate was 88.57%. The median follow-up
time was 5.8 (0.2-9.4) years, the 5-year overall
survival was 78.2% ± 5%, the
event-free survival (EFS) was 71.2% ± 5.6%, and the cumulative
recurrence rate was 27.75%. The 5-year EFS of
patients with initial WBC < 100 × 109/L (n = 59) and ⩾100 × 109/L (n = 11) were 76.4% ± 5.7% and 45.5% ± 15% (p = 0.013), respectively. A total of 650
hospital infections occurred. The main causes of
infection were
respiratory tract infection (26.92%),
septicemia (18.46%),
stomatitis (11.85%), and
skin and soft-
tissue infection (10.46%).
Conclusion:
This intensive
treatment protocol with dual induction and ALL-like elements is effective and safe for childhood AML. Initial WBC ⩾ 100 × 109/L was the only independent
risk factor in this cohort. Trial registration It is a
retrospective study, and no registration on ClinicalTrials.gov.
