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


Pediatric Blood & Cancer