MARKED IMPROVEMENTS IN OUTCOME WITH CHEMOTHERAPY ALONE IN PEDIATRIC ACUTE MYELOID-LEUKEMIA - RESULTS OF THE UNITED-KINGDOM MEDICAL-RESEARCHCOUNCILS 10TH AML TRIAL

359 eligible children with acute myeloid leukaemia (AML) entered the M RC AML 10 trial between May 1988 and March 1995. Patients received fou r courses of intensive induction and consolidation chemotherapy, with or without subsequent autologous (A-BMT) or allogeneic (allo-BMT) bone marrow transplant. There were randomized comparisons of thioguanine v ersus etoposide in induction and of A-BMT versus not. Allo-BMT was rec ommended for patients with a HLA-matched sibling and was evaluated by donor versus no donor comparison. The complete remission rate was 92%. In first remission there were 20 deaths during consolidation chemothe rapy and 11 after BMT (8/61 allo-BMTs. 1/60 A-BMTs and 2/4 matched unr elated donor transplants). The relapse rate was low, decreasing from 2 6% in the first year to 2% in the fourth. Long-term outcome was excell ent with survival at 7 years from entry of 56% and event-free survival of 48%. There were no significant differences between thioguanine and etoposide, whereas both A-BMT and allo-BMT reduced relapse risk but d id not produce a significant survival benefit. It appears that: over h alf the children entered into AML 10 are cured, a result which compare s favourably with other reported series. We conclude that four courses of intensive chemotherapy are an effective approach to the treatment of paediatric AML, which avoids the acute toxicity and long-term side- effects of BMT and also avoids the need for prolonged maintenance ther apy or cranial irradiation.