Definition of cure in childhood acute myeloid leukemia

Authors

  • Jeffrey E. Rubnitz MD, PhD,

    Corresponding author
    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    • Corresponding author: Jeffrey E. Rubnitz, MD, PhD, Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN 38105-2794; Fax: (901) 521-9005; Jeffrey.rubnitz@stjude.org

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  • Hiroto Inaba MD, PhD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Wing H. Leung MD, PhD,

    1. Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Stanley Pounds PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Xueyuan Cao PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Dario Campana MD, PhD,

    1. Department of Pediatrics, National University of Singapore, Singapore
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  • Raul C. Ribeiro MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Ching-Hon Pui MD

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    3. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
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  • The authors thank Kathy Jackson and Heidi Clough for data collection and Julie Groff for preparing the figures.

Abstract

BACKGROUND

A better understanding of when cure can be declared in childhood acute myeloid leukemia (AML) would reduce anxiety and improve quality of life of AML survivors. The authors determined the likelihood that patients with AML would maintain long-term remission after the completion of therapy.

METHODS

The cumulative risk of relapse, the time to relapse, event-free survival, and overall survival were analyzed for 604 patients with AML who were enrolled in 7 successive clinical trials divided into 3 treatment eras (1976-1991, 1991-1997, and 2002-2008).

RESULTS

The median time to relapse did not change over time (0.93 years vs 0.76 years vs 0.8 years, respectively, for each consecutive era; P = .22), but the risk of relapse decreased significantly (5-year cumulative incidence of relapse: 52.6% ± 3.1% vs 31.5% ± 3.9% vs 22% ± 3%, respectively, for each consecutive era; P < .001). Among patients who were in remission 4 years from diagnosis, the probabilities of relapse were 1.7%, 2.9%, and 0.9%, respectively, for each consecutive era. In the most recent era, all but 1 of 44 relapses occurred within 4 years of diagnosis.

CONCLUSIONS

Children with AML who receive treatment with contemporary therapy and remain in remission 4 years from diagnosis probably are cured. Although late relapses and late deaths from other causes are rare, long-term follow-up of survivors is necessary for the timely management of late adverse effects. Cancer 2014;120:2490–2496. © 2014 American Cancer Society.

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