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J Pediatr Hematol Oncol. 2018 Jan;40(1):43-47. doi: 10.1097/MPH.0000000000001034.

Acute Myeloid Leukemia With Central Nervous System Involvement in Children: Experience From the French Protocol Analysis ELAM02.

Author information

1
Department of Pediatric Hematology and Oncology, Trousseau Hospital.
2
Pediatric Hematology Department, Robert Debré Hospital.
3
Department of Pediatric Hematology and Oncology, UPMC University Paris, Sorbonne University.
4
Pediatric Hematology Department, University Hospital of Lille, Lille.
5
Department of Pediatric Hematology and Oncology, University Hospital of Lyon, Lyon.
6
Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes.
7
Pediatric Hematology and Oncology Department, University Hospital, Montpellier.
8
Department of Pediatric Hematology-Oncology, University Hospital, Strasbourg.
9
Department of Pediatric Hematology-Oncology, University Hospital, Nancy.
10
Department of Pediatric Hematology-Oncology, University Hospital, Nice.
11
Biological Hematology Department, Robert Debré Hospital, Paris.
12
Department of Pediatric Hematology and Oncology, Timone Children Hospital and Research Unit, Aix-Marseille University, Marseille, France.

Abstract

Central nervous system (CNS) involvement at diagnosis of pediatric acute myeloid leukemia (AML) is not considered as an independent prognostic factor. This study describes the prognostic value of pediatric AML with CNS involvement at diagnosis. Pediatric patients were treated for de novo AML in the French multicenter trial ELAM02. Lumbar puncture was carried out in the first week, and the treatment was adapted to the CNS status. No patient received CNS radiotherapy. The patients were classified into 2 groups: CNS+ and CNS-. Of the 438 patients, 16% (n=70) had CNS involvement at diagnosis, and 29% showed clinical signs. The patients with CNS disease were younger (40% were below 2 y old), had a higher white blood cell count (median of 45 vs. 13 G/L), and had M4 and M5 morphologies. The complete remission rate was similar at 92.8% for CNS+ and 88.5% for CNS-. There was no significant difference between the CNS+ and the CNS- group in overall survival (76% and 71%, respectively) and event-free survival (57% and 52%, respectively). Regarding the occurrence of first relapse, the CNS+ group had a higher combined relapse rate of 26.1% compared with 10% for the CNS- group. The results indicate that CNS involvement at diagnosis of pediatric AML is not an independent prognostic factor. Triple intrathecal chemotherapy combined with high-dose intravenous cytarabine should be the first-line treatment for CNS disease.

PMID:
29189507
DOI:
10.1097/MPH.0000000000001034
[Indexed for MEDLINE]

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