Impact of treatment on the outcome of acute myeloid leukemia with inversion 16: a single institution's experience

To identify treatment factors that may affect the survival of children with inv(16)(p13.1q22), we compared the outcomes of 19 patients with this genet ic feature treated at our institution during two treatment eras. Nine patie nts were treated during era 1 (1980 to 1987),and 10 were treated during era 2 (1988 to 1996). All entered complete remission (CR) with induction thera py. Eight of the nine children treated in era 1 died, seven of relapsed leu kemia. In contrast, three of 10 patients treated during era 2 have died, al l of non-disease-related causes. Event-free survival (EFS) estimates were s ignificantly higher for patients treated during era 2 than for those treate d during era 1 (P = 0.03); the 6-year estimates were 70 +/- 15% (s.e.) and 11 +/-7%, respectively. Era 2 treatment protocols differed from those of er a 1 in their use of higher doses of cytarabine and etoposide during inducti on and consolidation chemotherapy and in their use of 2-chlorodeoxyadenosin e (2-CDA). These results suggest that dose intensification of cytarabine be nefits children with AML and inv(16), as is the case in adults. They also s uggest that dose intensification of etoposide and addition of 2-CDA may als o offer an advantage. This study underscores the dependence of the prognost ic impact of cytogenetic features on the efficacy of treatment.