Results of Chemotherapy with BFM-87 Protocol in Children with Acute Myeloid Leukemia at a Referral Center in the Southwest of Iran: Clinical Characteristics and Outcome

Introduction: Leukemia is the most common malignancy in childhood, and acute myeloid leukemia (AML) is the second most common leukemia. AML still accounts for more than 30% of deaths from leukemia. AML is classified into several subgroups from M0 to M7 with different presentations, clinical features, and outcomes.

Material and Methods: Between March 1996 and October 2003, 47 children with acute myeloid leukemia were treated with intensive chemotherapy using BFM-87 protocol after remission at Shafa hospital, Ahwaz, Iran. We compared the presenting features and outcomes of therapy in these children based on age, initial White Blood Cells (WBC) count, Central Nervous System involvement, FAB system types, and response to first induction treatment.

Results: Younger children were more likely to have favourable risks and less likely to have induction deaths (p=0.03) and lower relapse risks (p=0.001). FAB types M2 and M4 showed a better first remission rate (p=0.01, p=0.02, respectively), regardless of age and gender. Two major risk factors for relapse after first remission were initial high WBC counts (p=0.01) and older age at the time of diagnosis (p=0.02). Overall survival (p=0.001), event-free survival (p=0.001), and disease-free survival were better (p<0.001) in younger children due to lower relapse rates (p=0.001). Discussion: Overall survival was 53% in the children with new AML who were on intensive chemotherapy with a median follow-up time of 5 years in our study. Relapse risk after first remission for the children who were on intensive chemotherapy alone was 34% in our study.

Conclusion: Because of the potential morbidity and mortality usually related to allogeneic HSCT and also problems due to lack of sufficient HSCT possibility for some patients, several cooperative group trials now do not recommend HSCT for good- or standard- risk patients in their first remission. Results of our study were compatible with BFM , AML 10 and AML 12 groups trials in terms of overall survival, or relapse risk, or induction death risk factors