Outcome for children with relapsed acute myeloid leukaemia following initial therapy in the Medical Research Council (MRC) AML 10 trial

Between May 1988 and March 1995, 359 children with acute myeloid leukaemia (AML) were treated in the MRC AML 10 trial. Three risk groups were identifi ed based on cytogenetics and response to treatment. One hundred and twenty- five children relapsed - 103 in the bone marrow only, 12 in the bone marrow combined with other sites, and six had isolated extramedullary relapses (s ite was not known in four cases). Eighty-seven children received further co mbination chemotherapy, one all-trans retinoic acid for acute promyelocytic leukaemia, and one a matched unrelated donor allograft in relapse, and 61 achieved a second remission. One patient with no details on reinduction the rapy also achieved second remission. Treatment in second remission Varied - 44 children received a BMT (22 autografts, 12 matched unrelated donor allo grafts, 10 family donor allografts), and 17 were treated with chemotherapy alone. The overall survival rate for all children (treated and untreated) w as 24% at 3 years, with a disease-free survival of 44% for those achieving a second remission. Length of first remission was the most important factor affecting response rates - children with a first remission of less than 1 year fared poorly (second remission rate 36%, 3 year survival 11%), whereas those with longer first remissions had a higher response rate (second remi ssion rate 75%, 3 year survival 49%, P < 0.0001).