Appropriate dose reduction in induction therapy is essential for the treatment of infants with acute myeloid leukemia: a report from the Japanese Pediatric Leukemia/Lymphoma Study Group

Springer Science and Business Media LLC - Tập 98 - Trang 578-588 - 2013
Daisuke Tomizawa1, Akio Tawa2, Tomoyuki Watanabe3, Akiko Moriya Saito4, Kazuko Kudo5, Takashi Taga6, Shotaro Iwamoto7, Akira Shimada8, Kiminori Terui9, Hiroshi Moritake10, Akitoshi Kinoshita11, Hiroyuki Takahashi12, Hideki Nakayama13, Nobutaka Kiyokawa14, Keiichi Isoyama15, Shuki Mizutani1, Junichi Hara16, Keizo Horibe4, Tatsutoshi Nakahata17, Souichi Adachi18
1Department of Pediatrics, Tokyo Medical and Dental University, Bunkyo-ku, Japan
2Department of Pediatrics, National Hospital Organization Osaka Medical Center, Osaka, Japan
3Department of Nutritional Science, Faculty of Psychological and Physical Science, Aichi Gakuin University, Aichi, Japan
4Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
5Division of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
6Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
7Department of Pediatrics, Mie University School of Medicine, Tsu, Japan
8Department of Pediatrics; Okayama University; Okayama Japan
9Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
10Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
11Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
12Department of Pediatrics, Toho University, Ota-ku, Japan
13Department of Pediatrics, National Hospital Organization, Fukuoka-Higashi Medical Center, Koga, Japan
14Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Setagaya-ku, Japan
15Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Japan
16Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
17Center for iPS cell Research and Application, Kyoto University, Kyoto, Japan
18Human Health Sciences, Kyoto University, Kyoto, Japan

Tóm tắt

Infants (<1 year old) with acute myeloid leukemia (AML) are particularly vulnerable to intensive cytotoxic therapy. Indeed, the mortality rate was high among infants enrolled in the Japanese Pediatric Leukemia/Lymphoma Study Group AML-05 study, which prompted us to temporarily suspend patient enrollment and amend the protocol. Forty-five infants with AML were enrolled. For patients aged <2 years, drug doses were adjusted for body weight. Following the protocol amendments, doses for infants were reduced by a further 33 % in the initial induction course. Six infants died during the induction phase (including five early deaths), mainly due to pulmonary complications. The 3-year probability of overall survival (pOS) in all 45 infants [55.9 %, 95 % confidence interval (CI) 37.9–70.6 %] was significantly lower than that of patients aged 1 to <2 years (77.0 %, 95 % CI 62.7–86.3 %) and those aged ≥2 years (74.7 %, 95 % CI 69.2–79.4 %) (P = 0.037), mainly due to the higher non-relapse mortality rate in infants. No early deaths occurred after the protocol amendments, and the 3-year pOS of the 17 infants enrolled thereafter was 76.4 % (95 % CI 48.8–90.4 %). In conclusion, appropriate dose reduction is essential to avoid early deaths when treating infants with AML.

Tài liệu tham khảo

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Springer Science and Business Media LLC

Tập 98

578-588

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