Fig. 3: To transplant or not to transplant in pediatric AML?
From: The hallmarks of hematopoietic stem cell transplantation for pediatric acute myeloid leukemia
Retrospective analyses have demonstrated that HSCT in CR1 improves OS with reduced RR in high-risk and r/r pediatric AML patients. The prognostic significance of NR or MRD-positivity before HSCT, as well as the association of subsequent HSCT with poorer survival outcomes, has been confirmed by various study groups. Numeric details are provided below: 1AML-BFM (2010-2012): 5-year pOS: 76% [183]; AIEOP-2002/01: 8-year pOS: 74% [205]. 2AML-BFM (2011-2012): CIR: 25.1% (SE 3.9), NR: 12.3% (SE 2.8) [183]; AIEOP-2002/01: CIR: 17% [205]. 3AML-BFM 2004/2012 and AML-BFM registry 2012: 5-year pOS 54.5%, SE = 4.4; COG (AAML0531 and AAML1031) (2013–2017): 5-year pOS 40%; 5-year pOS 24%, MRD+, COG: 5-year pOS 41%, MRD− [106]. 4BFM 2004/2012 and AML-BFM registry 2012: NR patients: 5-year pOS 26.7%, SE = 9.0 [106]. 5AML-SCT-BFM: CR1/CR2: 4-year pOS and pEFS 61 and 70%, CIR 22%, NRM 15% [107]. 62-year pLFS: CR 33%, NR 19%, 8-year pLFS: CR 24%, NR, 10% [206]. 4-year pOS w HSCT: 31% w/o 3%, CIR and NRM at 4 years: 45% and 22% [177]. *Consider maintenance therapy. AML acute myeloid leukemia, AML-MRC AML-myelodysplasia-related changes, PIF primary induction failure, s/t-AML secondary/therapy-related AML, r/r AML relapsed/refractory AML, MRD measurable residual disease, CR complete remission, NR no response, BFM Berlin–Frankfurt–Münster Study Group, COG Children’s Oncology Group, HSCT hematopoietic stem cell transplant, OS overall survival, RR relapse rate, CIR cumulative incidence of relapse, SE standard error, LFS leukemia-free survival, NRM non-relapse mortality.
