Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival.

TitleBlood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival.
Publication TypeJournal Article
Year of Publication2022
AuthorsPommert L, Cooper TM, Gerbing RB, Brodersen L, Loken M, Gamis A, Aplenc R, Alonzo TA, Kolb EAnders
JournalCancers (Basel)
Volume14
Issue3
Date Published2022 Jan 26
ISSN2072-6694
Abstract

International Working Group (IWG) and European LeukemiaNet (ELN) response definitions are utilized to evaluate the efficacy of new agents for childhood acute myeloid leukemia (AML) for regulatory purposes. However, these criteria are not consistent with definitions used in pediatric AML trials or with standard pediatric practice to proceed with subsequent therapy cycles prior to IWG/ELN-defined count recovery. We retrospectively analyzed data from the two most recent Phase 3 pediatric AML clinical trials conducted by the Children's Oncology Group (COG) to assess the incidence, timing, and prognostic significance of count recovery following induction chemotherapy. Of the patients with fewer than 5% bone marrow blasts at the end of first induction, 21.5% of patients proceeded to a second induction cycle prior to achieving ANC ≥ 500 cells/μL and platelets ≥ 50,000 cells/μL, both well below the IWG/ELN thresholds of ANC > 1000 cells/μL and platelets > 100,000 cells/μL. In these two sequential childhood AML Phase 3 trials, neither ANC nor platelet recovery predicted survival. Intensification of treatment through the initiation of subsequent therapy cycles prior to attainment of IWG/ELN-defined CR is common practice in clinical trials for children with AML, suggesting that updated response definitions are needed for pediatric AML.

DOI10.3390/cancers14030616
Alternate JournalCancers (Basel)
PubMed ID35158884
PubMed Central IDPMC8833679