Treatment related myeloid malignancies in childhood

Abstract

Incidence of treatment related AML/MDS (t-AML/MDS) in children is extremely low. Consequently assessment of data from adults and to some extent extrapolation from adults is needed. Epipodophyllotoxin induced t-AML/MDS is more common, which is likely to be related to the shorter latency period, FAB-M4, FAB-M5, APL, balanced karyotypes, 11q23 and 21q22 anomalies, inv(16) and t(15;17) are noted more often. Duration and short interval between administrations of epipodophyllotoxins results in higher incidence of t-AML/MDS. Genetic (karyotypic) make up influence duration of remission, although the relation with overall-survival is less clear. Choice of therapy should be based on co-morbidity and the likelihood to undergo intensive therapy. The majority of children with t-AML/MDS should have a transplantation. A minority of children with t-AML with inv(16), t(8;21) and t(15;19) should be considered for chemotherapy according to de-novo protocols. Monitoring of early response criteria for detection of primary resistance is advised.