Prognostic factors and outcome of recurrence in childhood acute myeloid leukemia

BACKGROUND. Outcome after recurrence of childhood acute myeloid leukemia (AML) is poor. We performed this study to identify prognostic factors for recurrence and for survival after recurrence of AML. METHODS. The clinical characteristics, biological features, treatment modalities, and outcomes of children with de novo AML who were enrolled on 3 consecutive clinical protocols from 1987 to 2002 at St. Jude Children's Research Hospital were studied. Regression modeling was used to identify prognostic factors for recurrence and for survival after recurrence. RESULTS. The outcome after recurrence was poor, with a 5-year survival estimate of only 23.3% +/- 5.7%. Multivariable analysis indicated that male sex (P = .005), autologous stem cell transplant before recurrence (P = .097), each additional month from diagnosis to recurrence (P = .041), and stem cell transplant after recurrence (P < .001) were associated with a better survival after recurrence, whereas M5 or M7 rnorphology (P = .001) were significantly predictive of a lower survival estimate after recurrence. CONCLUSION. Survival after recurrence was poor in children with AML. Novel therapies are urgently needed to prevent or to treat recurring AML. Cancer 2007;109:157-63. (c) 2006 American Cancer Society.