| Objective:To investigate long-term outcome and prognostic factors of childhood acute myeloid leukemia (AML) patients who accepted chemotherapy in the Affiliated Children’s Hospital of Zhejiang University School of Medicine.Methods:A total of126newly diagnosed AML at our hospital from January2005to October2008were enrolled in this study.49patients were abandoned,13patients lost follow-up,1died of intracranial hemorrhage. The remaining63cases accepting at least two cycles of chemotherapy were further analyzed for long-term survival and prognostic factors. For M3, patients received all-trans retinoic acid (ATRA) orally or ATRA associated with anthracycline (daunorubicin or pirurubicin or idarubicin) as an induction course, consolidation therapy consisted of three cycles of intermediate-or high-dose cytarabine(ID/HDAra-C) every other month, during the intervals of ID/HD Ara-C daunorubicin/cytarabine (DA), homoharringtonine/cytarabine (HA), and etoposide/cytarabine (EA) were given alternatively, maintenance therapy was given monthly by sequential HA, EA, and doxorubicin/paclitaxel (AT) cycles, and ATRA, central nervous system leukemia(CNS-L) prophylaxis was performed with triple intrathecal injection of cytarabine, methotrexate, and dexamethasone, the total course was2.5years. For non-M3, patients received DA or daunorubicin/cytarabine/etoposide (DAE) as an induction course, and the same cycle was repeated as consolidation therapy after achieving complete remission(CR), intensification therapy consisted of three cycles of ID/HDAra-C every other month, during the intervals of ID/HDAra-C DA, HA, EA were given alternatively, maintenance therapy was given monthly by sequential HA, EA, and doxorubicin/paclitaxel (AT) cycles, and ID/HDAra-C, CNS-L prophylaxis was performed with triple intrathecal injection, the total course was2.0years (girls) to2.5years(boys). Patients follow-ups were carried out via phone calls or outpatient clinics. All statistical analyses were performed using SPSS16.0software.Results:Among the63enrolled cases,60achieved CR, the total CR rate was95.2%,21M3and42non-M3, their CR rates were90.5%and97.6%(P>0.05), respectively. No CNS-L was observed when diagnosed.19patients relapsed among the60cases achieving CR, the total relapse rate was31.7%,2M3patients relapsed, one was only in the bone marrow(BM), and the other one patient experienced a combined relapse in the CNS and BM, the relapse rate for M3was10.5%,17non-M3patients all relapsed in the BM, and the relapse rate for non-M3was41.5%,higher than the M3patients obviously(P<0.05). One M3patient died of intracranial hemorrhage before achieving CR, another M3patient given up chemotherapy owing to not achieving CR on the372th day, then died.1relapsed M3patient was dead and the other one was in CR2. One non-M3patient given up chemotherapy owing to not achieving CR on the129th day,15relapsed M3patients were dead and the other two were in CR2. The5-year overall survival (OS) and event-free survival (EFS) rates for the63cases were69.8±5.8%and65.1±6.0%, respectively; the7-year OS and EFS rates were66.3±6.5%and62.4±6.3%, respectively. The5-year EFS rate for boys and girls were60.5±7.5%and75.0±9.7%, respectively (P>0.05). The5-year EFS rate for M3and non-M3were81.0±8.6%and57.1±7.6%, respectively (P>0.05). Prognostic factors analysis:on M3, gender, age, diagnostic White Blood Cell(WBC) level, socioeconomic status and PML/RARa positive or negative were all lack of association with the5-year EFS rate; and on non-M3, gender, age, diagnostic White Blood Cell(WBC) level and AML/ETO positive or negative were all lack of association with the5-year EFS rate, the5-year EFS rate for the non-M3patients from urban area were quite probably higher than those from rural area (76.9±11.7%vs48.3±9.3%,P=0.053).Conclusion:The treatment outcome of AML patients who could adhere to the treatment protocol was satisfactory. Relapse rate for M3was significantly lower than that for non-M3patients. |
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