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KMID : 0387820140210020080
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Clinical Pediatric Hematology-Oncology
2014 Volume.21 No. 2 p.80 ~ p.85
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Standard Induction Followed by Low Dose Cytarabine for the Treatment of Acute Myeloid Leukemia of Down Syndrome
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Kyung Ye-Chan
Choi Young-Bae
Lee Na-Hee
Lee Soo-Hyun
Sung Ki-Woong
Koo Hong-Hoe
Yoo Keon-Hee
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Abstract
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Background: Although acute myeloid leukemia occurring in patients with Down syn-drome (AML-DS) is generally chemosensitive, these patients are more susceptible to regi-men-related toxicities, and the optimal post-remission therapy for AML-DS is unknown. This study aimed to evaluate the outcome of post-remission chemotherapy using low dose cytarabine for AML-DS.
Methods: We reviewed the medical records of 142 patients who were newly diagnosed as de novo AML between 1996 and 2011. Among them, 8 patients (5.6%) had Down syndrome. Seven patients received standard induction therapy composed of cytarabine (or behenoyl cytarabine) and anthracycline. Once complete remission (CR) was ach-ieved, repetitive courses of low dose cytarabine were given.
Results: Patients’ median age at diagnosis was 1.3 years (range, 0.4-1.9). All but one showed French-American-British (FAB) M7 morphology. Six patients achieved CR (75%) after induction therapy and then received 9 to 20 courses (median, 14) of low dose cytarabine. One patient had 2 episodes of neutropenic fever, whereas the other 5 pa-tients did not suffer from any complication. All six patients are alive event-free with a median follow-up of 118 months (range, 33-208). The estimated 5-year overall survival of all 8 AML-DS patients was 87.5%, while that of non-DS de novo AML patients was 58.6% (P=0.18).
Conclusion: Low dose cytarabine was safe and effective as a post-remission therapy for AML-DS. Due to the rarity of AML-DS, a multicenter cooperative study is essential to identify the optimal duration of treatment and to further determine the feasibility of low dose cytarabine for these patients.
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KEYWORD
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Acute myeloid leukemia, Down syndrome, Low dose cytarabine, Post-re-mission therapy
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