PROGNOSIS OF CHILDREN WITH FIRST RELAPSE OF AML

Nearly 40% of children treated within the AML BFM studies experience r ecurrence of their disease after having achieved remission. In our ret rospective analysis we tried to estimate prognosis after relapse in ch ildren treated with intensive relapse regimens and studied the impact of prognostic factors for second remission and survival. Patients 102 patients suffering from first relapse were treated intensively accordi ng to the relapse protocols BFM REZ91 and REZ93 or intensive salvage t herapy consisting of double induction with high dose Ara-C, mitoxantro ne and VP-16. Once in CR, patients continued to receive a 6-week conso lidation and either allogeneic or autologous bone marrow transplantati on (BMT). Results Time to relapse was in median 1.1 years, range 0-8 y ears. Fifty-two of 102 pts. (51%) achieved 2nd remission (CR), 10 (10% ) partial remission, 37 (36%) were nonresponders, and 3(3%) died early during salvage therapy. Twenty-seven were still in CR, median 2.5 yea rs, range 0.4-7.0 years, with an overall survival of 21%, SE 5% after 5 years. The response and survival rate was similar in all treatment g roups. Fifty patients were transplanted, 43 being in 2nd CR, and 7 wit h residual blasts. Twenty-seven patients received an allograft: Twenty -one from a matched sibling (MSD), 1 from a haploid and 5 from a match ed unrelated donor (MUD); 23 received an autograft. None of the patien ts transplanted in partial remission survived. Whereas 7 of 16 patient s were alive after MSD in 2nd CR, 1 after haploid BMT. Four of 5 patie nts died after MUD BMT. Multivariate risk factor analysis revealed dur ation until relapse to be the mast important factor for survival after relapse. The maximum risk-ratio was obtained at a threshhold value of 1:5 years after diagnosis resulting in a 5-year survival of 10%, SE 5 % for early relapse, and 40%, SE 10% for late relapse, p logrank 0.000 1. Conclusion Intensive relapse regimens can induce a 2nd CR in half o f the patients. Children with late relapse (>1.5 years after diagnosis ) have a realistic chance for longtime survival.