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Blood, 15 December 2001, Vol. 98, No. 13, pp. 3589-3594
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Superior outcome of infant acute myeloid leukemia with intensive
chemotherapy: results of the Japan Infant Leukemia Study Group
Hajime Kawasaki,
Keiichi Isoyama,
Mariko Eguchi,
Shigeyoshi Hibi,
Naoko Kinukawa,
Yoshiyuki Kosaka,
Takanori Oda,
Megumi Oda,
Shin-ichiro Nishimura,
Masue Imaizumi,
Takayuki Okamura,
Teruaki Hongo,
Hiroji Okawa,
Shuki Mizutani,
Yasuhide Hayashi,
Ichiro Tsukimoto,
Nanao Kamada, and
Eiichi Ishii
From the Department of Pediatrics, Mie University,
Japan; Department of Pediatrics, Showa University Fujigaoka Hospital,
Japan; Department of Cancer Cytogenetics, Research Institute for
Radiation Biology and Medicine, Hiroshima University, and Department of
Pediatrics, Hiroshima University School of Medicine, Japan; Department
of Pediatrics, Kyoto Prefectural University of Medicine, Japan;
Department of Medical Information Science, Faculty of Medicine, Kyushu
University, Japan; Department of Pediatrics, Faculty of Medicine, Kobe
University School of Medicine, Japan; Department of Pediatrics, Sapporo
Medical University School of Medicine, Japan; Department of Pediatrics,
Okayama University School of Medicine, Japan; Department of Pediatric
Hematology and Oncology, Tohoku University School of Medicine, Japan;
Division of Pediatrics, Osaka Medical Center and Research Institute for
Maternal and Child Health, Japan; Department of Pediatrics, Hamamatsu
University School of Medicine, Japan; Department of Pediatrics, Saga
Medical School, Japan; Department of Pediatrics, Tokyo Medical and
Dental University School of Medicine; Department of Pediatrics,
Graduate School of Medicine, University of Tokyo; and Department of
Pediatrics, Toho University School of Medicine, Japan.
This study analyzed data on 35 infants with acute myeloid leukemia
(AML) who were treated with intensive chemotherapy between 1995 and
1998 in Japan. The incidence of boys, younger age (< 6 months old),
and hyperleukocytosis at onset was high in patients with the M4/M5
subtype (n = 23) in the French-American-British classification,
compared with the non-M4/M5 subtype (n = 12). Thirteen (56%) and 16 (70%) patients with the M4/M5 subtype also showed 11q23 translocations
and MLL gene rearrangements, respectively, whereas only one
patient with the non-M4/M5 subtype had this rearrangement. All 35 patients were treated with the ANLL91 protocol consisting of etoposide,
high-dose cytarabine, and anthracyclines. Overall survival and the
event-free survival (EFS) rates at 3 years of all patients were 76%
(95% confidence interval [CI], 61.3%-90.7%) and 72% (95% CI,
56.4%-87.9%), respectively. EFS showed no significant difference
between 2 subgroups divided by age, gender, presence of the
MLL gene rearrangements, and white blood cell count at onset; EFS in patients with the M4/M5 subtype tended to be better than
those with the non-M4/M5 subtype. Although all 6 patients who underwent
allogeneic stem cell transplantation (SCT) have been in complete
remission, no benefit of SCT was confirmed. These findings suggest that
the intensive chemotherapy with the ANLL91 protocol might have been
responsible for the observed good outcome of infant AML, even without
SCT. The presence of the MLL gene rearrangements or the age
at onset had no impact on the outcome of infant AML.
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Blood 2002 99: 2626-2627.
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