Intensive chemotherapy with dual induction and ALL-like consolidation for childhood acute myeloid leukemia: a respective report from multiple centers in China

IF 3.4 3区医学 Q2 HEMATOLOGY

Therapeutic Advances in Hematology Pub Date : 2024-05-31 DOI:10.1177/20406207241256894

Jia-Nan Li, Yi-Jun Chen, Zhong Fan, Qiao-Ru Li, Liu-Hua Liao, Zhi-Yong Ke, Yu Li, Li-Na Wang, Cui-Yun Yang, Xue-Qun Luo, Yan-Lai Tang, Xiao-Li Zhang, Li-Bin Huang

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引用次数: 0

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.

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儿童急性髓性白血病的双诱导强化化疗和类ALL巩固治疗：来自中国多个中心的报告

背景:小儿急性髓性白血病（AML）预后差、复发率和死亡率高，目前仍亟需探索新的治疗方案。目的:总结我国以双诱导和急性淋巴细胞白血病（ALL）要素巩固治疗为特点的小儿AML新治疗策略的疗效。设计：回顾性、单臂研究。方法：2012年7月至2019年12月，我们对新诊断的急性髓细胞白血病患儿采用了强化化疗方案，其中包括双诱导、三个疗程以大剂量阿糖胞苷为基础的巩固治疗，以及两个疗程由大剂量甲氨蝶呤、长春新碱、天冬酰胺酶和巯嘌呤（ALL类元素）组成的巩固治疗。每隔一段时间通过骨髓涂片监测血细胞，并在化疗期间进行两次腰椎穿刺。我们对这项研究的疗效和安全性进行了回顾性分析。最后一次随访是在 2023 年 5 月 26 日。诊断时的中位年龄为6.7（0.5-16.0）岁。初始白细胞计数中位数为 23.74 × 109/L，其中 11 例超过 100 × 109/L。双诱导后，完全缓解（CR）62 例，部分缓解 5 例，未缓解 3 例。CR率为88.57%。中位随访时间为5.8（0.2-9.4）年，5年总生存率为78.2%±5%，无事件生存率（EFS）为71.2%±5.6%，累积复发率为27.75%。初始 WBC < 100 × 109/L （59 人）和 ⩾100 × 109/L （11 人）患者的 5 年无事件生存率分别为 76.4% ± 5.7% 和 45.5% ± 15% （P = 0.013）。共发生了 650 例医院感染。感染的主要原因是呼吸道感染（26.92%）、败血症（18.46%）、口腔炎（11.85%）以及皮肤和软组织感染（10.46%）。试验注册：这是一项回顾性研究，未在ClinicalTrials.gov上注册。

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来源期刊

Therapeutic Advances in Hematology HEMATOLOGY-

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

7 weeks

期刊介绍： Therapeutic Advances in Hematology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of hematology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in hematology, providing a forum in print and online for publishing the highest quality articles in this area.