PB005 Treatment of DS-AML without HDARAC does not impact on disease outcome

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Purpose: Disease related outcome for DS children with AML is higher than non-DS patients, but with more toxicity. Optimally intensive therapy for DS-AML needs to be determined.
Method: We retrospectively reviewed the outcome of DS-AML at our institution between 2000 and 2009 treated on two different protocols; Group A utilized HDARAC post-induction and Group B was treated without HDARAC.
Results: Twenty patients were treated; 10 patients in each group. There were 15 boys, and the median age was 27.7 months (mean 43.2+6.9; 8<2 yrs, 9 2–4 years and3>4 years). The clinical characteristics of patients in the two groups were similar (median age 29.5 v. 24.2 mo; mean WBC 27.5 v. 13.8 X 109/L; Hg 74.4 v. 80.1 g/L; plt54 v. 18 X109/L, p>0.5 for all). Seven patients had M7 and 8 M2 subtype. Two had CSF positivity. Eight patients had congenital cardiac abnormalities and one dysplastic kidney. One patient in each Arm failed to achieve CR following 2 induction cycles, but both achieved CR following HDARAC. Six have relapsed (Group A¼3, GroupB¼3) at a median of 4.2 months from CR. 5-year OS is 80.4% and RFS is 67.7%. There was no difference in OS or RFS between the two groups (OS 78.8% v. 80%, p=0.7; RFS 70% v. 62.2%, p=0.9). No difference was found for induction-phase toxicity, however there was significantly more infectious toxicity with Group A postinduction (9 v. 3 patients, p=0.02). Specifically, 13 v. 1 episode of F/N (p=0.001), 4v. 0 invasive fungal infections (p=0.082), 3 v. 1 non-BS bacterial infections(p=0.12) and 4 v. 2 BS bacterial infections (p=0.6). Three patients in Group B developed subclinical reduction in cardiac function.
Conclusion: Treatment of DS-AML is feasible without HD-ARAC for most DS-AML patients. HDARAC is associated with increase infectious toxicity without improving disease free survival.


This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Pediatric Blood & Cancer