260 A Single Centre Retrospective Study of Cytogenetic Profile, Management and Outcome of Acute Myeloid Leukaemia in Children

Abstract

Purpose: AML 15 was the first major trial to compare anthracycline based consolidation (MACE/MidAC) to a Cytosine-Arabinoside (araC) based consolidation. Following closure of the trial, standard therapy of cytosine-arabinoside consolidation therapy is currently recommended. In 2010, 14 patients were diagnosed and treated for Acute Myeloid Leukaemia in the Royal Marsden hospital and >70% have subsequently relapsed. This prompted a review of the cytogenetic, treatment and outcome profiles for all patients diagnosed with Acute Myeloid Leukaemia. Methods: A retrospective study was conducted at the Royal Marsden Hospital on children (aged less than 18), diagnosed to have acute Myeloid Leukaemia between January 2004 and December 2011. A total of 72 patients were identified, of which 19 patients were excluded. Results: 7 patients had primary induction failure following standard treatment with ADE (Cytosine Araginoside, Daunorubicin and Etoposide). 48 patients were appropriate for comparison between the two consolidation treatment groups. 22 patients received treatment with cytosine-arabinoside (ara-C) based consolidation and 26 patients received treatment with anthracycline based therapy (MACE/MIDAC). 9 patients (41%) in the araC group relapsed and 3 of these patients subsequently died. In only 1 patient this was secondary to resistant disease. Of the 9 patients who relapsed 6 had adverse cytogenetics.Within the group of patients treated with MACE/MIDAC consolidation, 14 relapsed (54%) and of these, 9 patients subsequently died. 6 of the 13 relapsed patients had cytogenetic abnormalities known to be associated with adverse outcome, and one patient had favourable cytogenetics. No patient within the MACE/MiDAC group had treatment changed due to cardiotoxicity. Chi-squared analysis of both groups identified no significant difference in the rate of deaths with 0.05 < p < 0.1. Conclusion: Rate of relapse and death occurs more frequently in the group of patients treated with anthracycline based consolidation therapy, although this has not reached the standard level of significance.