Langermann Hj

Improved treatment results in childhood acute myelogenous leukemia: a report of the German cooperative study AML-BFM-78

One hundred fifty-one children with acute myelogenous leukemia (AML) entered the cooperative study BFM-78 between December 1978 and October 1982. The initial therapy consisted of an intensive induction and consolidation regimen over eight weeks with seven different drugs and cranial irradiation. It was followed by maintenance with thioguanine and cytosine arabinoside for two years and additional Adriamycin during the first year. One hundred nineteen (79%) patients achieved a complete remission. Thirteen (9%) children died of early hemorrhages. After a median follow-up time of 36 (12 to 57) months, 47 relapses have occurred, with CNS involvement in seven cases. The life table analysis revealed a probability for overall survival after almost five years of 45% (SD, 4%), for event-free survival 41% (SD, 4%), and for the event-free interval 52% (SD, 5%). Up to now, no relapse was seen after 2 1/2 years. Risk factor analysis showed that early fatal hemorrhages occurred predominantly in children with M5 FAB type and with initial leukocytosis. An initial high WBC count and liver enlargement were unfavorable parameters for achieving remission. No factors could be identified concerning the risk for relapse. These data indicate that the applied treatment strategy is successful in inducing complete remissions in about three fourths of children with AML and also in enhancing considerably the chances for long-term remission.

Treatment Strategy for Different Risk Groups in Childhood Acute Lymphoblastic Leukemia: A Report From the BFM Study Group

Development of effective treatment programs for childhood acute lymphoblastic leukemia (ALL) has led to marked improvement of prognosis. The proportion of patients remaining in first remission for at least 5 years is generally estimated to be in the range of 50% once remission is achieved (Frei and Sallan 1978: Riehm et al. 1980: Robison et al. 1980). Since remission rates have been shown to be 90%–95% with currently used induction therapy, successful induction of remission is no longer an essential problem. Nevertheless, the quality of remission is apparently unsatisfactory in about one-half of the patients, eventually resulting in recurrence of the disease. Predictors of outcome have been defined and include white blood count (WBC), sex, thymic involvement, central nervous system disease at diagnosis, immunologic markers, unfavorable age, and blast cell morphology (Dow et al. 1977; Henze et al. 1979; Mathe et al. 1971; Sallan et al. 1978: Simone et al. 1975: Wagner and Baehner 1979; Working Party on leukemia in Childhood 1978): but attempts to adapt the therapeutic strategy to the presence of factors associated with a poor prognosis have not been able to enhance significantly therapeutic results. The approach of the BFM study group with the concept of intensive multidrug remission induction gives hope for an overall 75 % relapse-free survival in childhood ALL.

Improved Results in Treatment of Acute Myelogenous Leukemia in Children — Report of the German Cooperative AML Study BFM-78

Recently the treatment programs for childhood acute myeloid leukemia (AML) have become more effective, not only in achieving a higher percentage of induction responses but also in the improvement of duration of the first remission [7, 9, 12], Because AML in children is rare — about 80 new cases per year are expected in West Germany and West Berlin – it is necessary to cooperate in multicenter trials to gain experience and to establish the value of new therapies.