Retrospective Study of Remission Failure in Childhood Acute Myeloid Leukemia

Abstract

The remission failure cases in childhood acute myeloid leukemia (AML) treated in our institute were retrospectively analyzed. From 1991 to 1999, twenty-three AML patients (10 boys and 13 girls), aged 2 months to 19 years, were admitted to our hospital. Six of 23 patients (26%) failed to achieve complete remission : 2 cases of FAB-M0, 1 case of M1, 1 case of M5, and 2 cases of M6. Among them, 2 cases manifesting hyperleukocytosis died before induction therapy and 4 could not achieve complete remission in spite of multimodal induction chemotherapy. Four refractory cases showed FAB-MO or M6 morphology previously reported as poor prognosis subtypes. No complication death during induction therapy was observed. The treatment strategy for these cases is discussed. Cases with hyperleukocytosis should receive immediate and sufficient preinduction leukapheresis and intensive supportive care. For the cases refractory to conventional chemotherapy, myeloablative therapy with stem cell transplantation (SCT) for remission induction is indicated. Double SCT may be taken into consideration for extreme refractory cases.