Results of hemopoietic cell transplantation in the first complete remission in children with acute myeloid leukemia from an intermediate risk group
- Authors: Dyshlevaya ZM1, Skorobogatova EV1, Maschan MA2, Shipitsyna IP1, Skvortsova Y.V1, Trakhtman PE1, Balashov DN1, Pashko Y.V1, Kurnikova EE1, Suntsova EV1, Goronkova OV1, Solopova GG1, Baidildina DD1, Kalinina II1, Khachatryan LA1, Shneider MM2, Maschan AA2
-
Affiliations:
- Russian Children's Hospital, Moscow
- Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
- Issue: Vol 82, No 7 (2010)
- Pages: 34-40
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/30616
- ID: 30616
Cite item
Full Text
Abstract
Subjects and methods. The study enrolled 36 children from an intermediate risk group, who had undergone auto-HCT (n = 22) or allo-HCT (n = 14) in December 1994 to December 2008. The patients' age was 0.7 to 16.6 years (median 12.8 years). Chemotherapeutic conditioning regimens were applied to all the patients. Melphalan was a basic myeloablative agent in 83.3% of cases.
Results. With a median follow-up of 4.6 years (1.1-13.8 years), three-year relapse-free survival (RFS) was 80.4%; overall survival (OS) was 65.6%. Recurrences were documented only in 6 (16.6%) patients from the auto-HCT. Transplantation-associated mortality (TAM) was 13.8% (five patients died). After allo-HCT versus auto-HCT, RFS, OS, and TAM were 100 and 68.7% (p = 0.03), 93.2 and 55.5% (p = 0.02), and 7.1 and 18.2%, respectively. Acute and chronic graft-versus-host reactions developed in 57.1 and 23.1%, respectively.
Conclusion. Transplantation of allogeneic hemopoietic cells from a compatible related donor in the intermediate risk group children with AML, by using melphalan-based conditioning regimen, demonstrates a high survival rate with the minimum toxicity.
About the authors
Z M Dyshlevaya
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
E V Skorobogatova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
M A Maschan
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
I P Shipitsyna
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
Yu V Skvortsova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
P E Trakhtman
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
D N Balashov
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
Yu V Pashko
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
E E Kurnikova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
E V Suntsova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
O V Goronkova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
G G Solopova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
D D Baidildina
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
I I Kalinina
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
L A Khachatryan
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
M M Shneider
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
A A Maschan
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
References
- Creutzig U., Ritter J., Zimmermann M. et al. Improved treatment results in high-risk pediatric acute myeloid leukemia patients after intensification with high-dose cytarabine and mitoxantrone: results of Study Acute Myeloid Leukemia-Berlin-Frankfurt-Münster 93. J. Clin. Oncol. 2001; 19 (10): 2705- 2713.
- Lie S. O., Abrahamsson J., Clausen N. et al. Long-term results in children with AML: NOPHO-AML Study Group-report of three consecutive trials. Leukemia 2005; 19 (12): 2090-2100.
- Creutzig U., Zimmermann M., Ritter I. et al. Treatment strategies and long-term results in paediatric patients treated in four consecutive AML-BFM trials. Leukemia 2005; 19 (12): 2030- 2042.
- Kardos G., Zwaan C. M., Kaspers G. J. et al. Treatment strategy and results in children treated on three Dutch Childhood Oncology Group acute myeloid leukemia trials. Leukemia 2005; 19 (12): 2063-2071.
- Wheatley K., Burnett A. K., Goldstone A. H. et al. A simple, robust, validated and highly predictive index for the determination of risk-directed therapy in acute myeloid leukaemia derived from the MRC-AML-10 trial. United Kingdom Medical Research Council's Adult and Childhood Leukaemia Working Parties. Br. J. Haematol. 1999; 107 (1): 69-79.
- Grimwade D., Walker H., Oliver F. et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC-AML-10 trial. The Medical Research Council Adult and Children's Leukaemia Working Parties. Blood 1998; 92 (7): 2322-2333.
- Burnett A. K., Goldstone A. H., Stevens R. M. et al. Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC-AML-10 trial. UK Medical Research Council Adult and Children's Leukaemia Working Parties. Lancet 1998; 351 (9104): 700-708.
- Woods W. G., Neudorf S., Gold S. et al. A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission. Blood 2001; 97 (1): 56- 62.
- Ravindranath Y., Yeager A. M., Chang M. N. et al. Autologous bone marrow transplantation versus intensive consolidation chemotherapy for acute myeloid leukemia in childhood. Pediatric Oncology Group. N. Engl. J. Med. 1996; 334 (22): 1428-1434.
- Creutzig U., Reinhardt D., Zimmermann M. AML-BFM Study Group. Prognostic relevance of risk groups in the pediatric AML-BFM trials 93 and 98. Ann. Hematol. 2004; 83 (suppl. 1): S112-S116.
- Michel G., Leverger G., Leblanc T. et al. Allogeneic bone marrow transplantation vs aggressive post-remission chemotherapy for children with acute myeloid leukemia in first complete remission. A prospective study from the French Society of Pediatric Hematology and Immunology (SHIP). Bone Marrow Transplant. 1996; 17 (2): 191-196.
- Kaspers G. J. L., Zimmermann M., Reinhardy D. et al. Addition of liposomal daunorubicin (DaunoXome®) to FLAG significantly improves treatment response in pediatric relapsed AML: Final results from the International Randomised Phase III Study Relapsed AML 2001/01. Blood 2009; 114 (ASH Annual Meeting Abstracts): 18.
- Abrahamsson J., Clausen N., Gustafsson G. et al. Improved outcome after relapse in children with acute myeloid leukaemia. Br. J. Haematol. 2007; 136 (2):229-236.
- Michel G., Leverger G., Leblanc T. et al. Allogeneic bone marrow transplantation vs aggressive post-remission chemotherapy for children with acute myeloid leukemia in first complete remission. A prospective study from the French Society of Pediatric Hematology and Immunology (SHIP). Bone Marrow Transplant. 1996;17 (2): 191-196.
- Cesaro S., Meloni Q., Messina C. High-dose melphalan with autologous hemopoietic stem cell transplantation for acute myeloid leukemia: results of retrospective analysis of Italian Pediatric Group for Bone Marrow Transplantation. Bone Marrow Transplant. 2001; 28: 131-136.
- Giralt S., Aleman A., Anagnostopoulos A. et al. Fludarabine/ melphalan conditioning for allogeneic transplantation in patients with multiple myeloma. Bone Marrow Transplant. 2002; 30 (6): 367-373.
- van Besien K., Kunavakkam R., Rondon G. et al. Fludarabine-melphalan conditioning for AML and MDS: alemtuzumab reduces acute and chronic GVHD without affecting long-term outcomes. Biol. Blood Marrow Transplant. 2009; 15 (5):610- 617.
- Tiedemann K., Waters K. D., Tauro G. P. et al. Results of intensive therapy in childhood acute myeloid leukemia, incorporating high-dose melphalan and autologous bone marrow transplantation in first complete remission. Blood 1993; 82 (12): 3730-3738.
- Inamoto Y., Oba T., Miyamura K. et al. Stable engraftment after a conditioning regimen with fludarabine and melphalan for bone marrow transplantation from an unrelated donor. Int. J. Hematol. 2006; 83 (4): 356-362.
- Singhal S., Powles R., Treleaven J. et al. Melphalan alone prior to allogeneic bone marrow transplantation from HLA-identical sibling donors for hematologic malignancies: alloengraftment with potential preservation of fertility in women. Bone Marrow Transplant. 1996; 18 (6): 1049-1055.
- Тиганова О. А., Шнейдер М. М., Тимакова М. В. и др. Результаты лечения острых миелоидных лейкозов по протоколу НИИ детской гематологии ИДГ-ОМЛ-93. Гематол. и трансфузиол. 2001; 4: 14-18.
- Литвинко Н. П., Шнейдер М. М., Савва Н. Н. и др. Лечение острого миелолейкоза у детей по протоколу ОМЛ-2000: предварительные результаты исследования кооперативной группы Россия-Беларусь. Вопр. гематол./онкол. и иммунопатол. в педиатр. 2006; 5 (3): 23-32.
- Filipovich A. H., Weisdorf D., Pavletic S. et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol. Blood Marrow Transplant. 2005; 11 (12): 945-956.
- Shulmann H., Sullivan K. M., Weiden P. L. et al. Chronic graft-versus-host disease in man: a clinic pathologic study of 20 long term Seattle patients. Am. J. Med. 1980; 69: 204-217.
- Gibson B. E., Wheatley K., Hann I. M. et al. Treatment strategy and long-term results in pediatric patients treated in consecutive UK AML trials. Leukemia 2005; 19: 2130-2138.
- Gassas A., Afzal S., Ishaqi M. K. et al. Pediatric standart-risk AML with fully matched sibling donors: to transplant in first CR or not? Bone Marrow Transplant. 2008; 42: 393-396.
- Cesaro S., Meloni G., Messina Q. et al. High-dose melphalan with autologous hemopoietic stem cell transplantation for acute myeloid leukemia: results of retrospective analysis of Italian Pediatric Group for Bone Marrow Transplantation. Bone Marrow Transplant. 2001; 28: 131-136.
- Smith F. O., Alonzo T. A., Gerbing R. B. Long-term results of children with acute myeloid leukemia: a report of three consecutive Phase III trials by the Children Cancer Group. Leukemia 2005; 19: 2054-2062.
- Matsuyama T., Horibe K., Kato K. et al. Bone marrow transplantation for children with acute myelogenous leukemia in first complete remission. Eur. J. Cancer 2000; 36: 368-375.
![](/img/style/loading.gif)