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Meta-Analysis
. 2008 Dec 10;26(35):5797-801.
doi: 10.1200/JCO.2007.13.5244. Epub 2008 Oct 27.

Impact of disease risk on efficacy of matched related bone marrow transplantation for pediatric acute myeloid leukemia: the Children's Oncology Group

John T Horan  1 , Todd A Alonzo, Gary H Lyman, Robert B Gerbing, Beverly J Lange, Yaddanapudi Ravindranath, David Becton, Franklin O Smith, William G Woods; Children's Oncology Group
Affiliations
Meta-Analysis

Impact of disease risk on efficacy of matched related bone marrow transplantation for pediatric acute myeloid leukemia: the Children's Oncology Group

John T Horan et al. J Clin Oncol. .

Abstract

Purpose: There is considerable variation in the use of HLA-matched related bone marrow transplantation (BMT) for the treatment of pediatric patients with newly diagnosed acute myeloid leukemia (AML). Some oncologists have argued that BMT should be offered to most patients in first complete remission (CR). Others have maintained that transplantation in first remission should be reserved for patients with high-risk disease. We performed this study to determine how disease risk influences the efficacy of BMT.

Methods: We combined data from four cooperative group clinical trials: Pediatric Oncology Group 8821, Children's Cancer Group (CCG) 2891, CCG 2961, and Medical Research Council 10. Using cytogenetics and the percentage of marrow blasts after the first course of chemotherapy, patients were stratified into favorable, intermediate, and poor-risk disease groups. Patients who could not be risk classified were analyzed separately. Outcomes for patients assigned to BMT and for patients assigned to chemotherapy alone were compared.

Results: The data set included 1,373 pediatric patients with AML in first CR. In the intermediate-risk group, the estimated disease-free survival at 8 years for patients who did not undergo transplantation was 39% +/- 5% (2 SE), whereas it was 58% +/- 7% for BMT patients. The estimated overall survival for patients who did not undergo transplantation was 51% +/- 5%, whereas it was 62% +/- 7% for BMT patients. Both differences were significant (P < .01). There were no significant differences for survival in the other two risk groups or in the non-risk-stratified patients.

Conclusion: Our study indicates that HLA-matched related BMT is an effective treatment for pediatric patients with intermediate-risk AML in first CR.

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Figures

Fig 1.
Fig 1.
Estimated overall survival stratified by risk group and postremission treatment. Chemo, chemotherapy; BMT, bone marrow transplantation.
Fig 2.
Fig 2.
Estimated disease-free survival (DFS), treatment-related mortality (TRM), and relapse for intermediate-risk patients. BMT, bone marrow transplantation; Chemo, chemotherapy.
See this image and copyright information in PMC

References

    1. Pession A, Rondelli R, Basso G, et al: Treatment and long-term results in children with acute myeloid leukaemia treated according to the AIEOP AML protocols. Leukemia 19:2043-2053, 2005 - PubMed
    1. Becton D, Dahl GV, Ravindranath Y, et al: Randomized use of cyclosporin A (CsA) to modulate P-glycoprotein in children with AML in remission: Pediatric Oncology Group Study 9421. Blood 107:1315-1324, 2006 - PMC - PubMed
    1. Creutzig U, Zimmermann M, Lehrnbecher T, et al: Less toxicity by optimizing chemotherapy, but not by addition of granulocyte colony-stimulating factor in children and adolescents with acute myeloid leukemia: Results of AML-BFM 98. J Clin Oncol 24:4499-4506, 2006 - PubMed
    1. Gibson BE, Wheatley K, Hann IM, et al: Treatment strategy and long-term results in paediatric patients treated in consecutive UK AML trials. Leukemia 19:2130-2138, 2005 - PubMed
    1. Perel Y, Auvrignon A, Leblanc T, et al: Treatment of childhood acute myeloblastic leukemia: Dose intensification improves outcome and maintenance therapy is of no benefit—Multicenter studies of the French LAME (Leucemie Aigue Myeloblastique Enfant) Cooperative Group. Leukemia 19:2082-2089, 2005 - PubMed

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