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Graff Z, Wachter F, Eapen M, Lehmann L, Cooper T. Navigating Treatment Options and Communication in Relapsed Pediatric AML. Am Soc Clin Oncol Educ Book 2024; 44:e438690. [PMID: 38862135 DOI: 10.1200/edbk_438690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Despite improved outcomes in newly diagnosed pediatric AML, relapsed disease remains a therapeutic challenge. Factors contributing to slow progress in improving outcomes include inherent challenges in pediatric clinical trial accrual and the scarcity of novel targeted/immunotherapy agents available for pediatric development. This paradigm is changing, however, as international collaboration grows in parallel with the development of promising targeted agents. In this review, we discuss the therapeutic landscape of relapsed pediatric AML, including conventional chemotherapy, targeted therapies, and the challenges of drug approvals in this patient population. We highlight current efforts to improve communication among academia, industry, and regulatory authorities and discuss the importance of international collaboration to improve access to new therapies. Among the therapeutic options, we highlight the approach to second hematopoietic stem cell transplant (HSCT) and discuss which patients are most likely to benefit from this potentially curative intervention. Importantly, we acknowledge the challenges in providing these high-risk interventions to our patients and their families and the importance of shared communication and decision making when considering early-phase clinical trials and second HSCT.
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Affiliation(s)
- Zachary Graff
- Department of Pediatrics, Division of Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, WI
| | - Franziska Wachter
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mary Eapen
- Department of Medicine, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Todd Cooper
- Department of Pediatrics, Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA
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Lee JH, Ju HY, Hyun JK, Kim SJ, Cho HW, Lee JK, Lee JW, Sung KW, Yoo KH. Treatment outcome and prognostic factors in relapsed pediatric acute myeloid leukemia. Blood Res 2023; 58:181-186. [PMID: 37926557 PMCID: PMC10758629 DOI: 10.5045/br.2023.2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Despite improved outcomes for pediatric patients with acute myeloid leukemia (AML), the prognosis for relapse remains poor. This study aimed to examine the clinical factors associated with prognosis in relapsed pediatric AML. Methods We conducted a chart review of pediatric patients with AML who experienced their first relapse and received treatment at our institution between 2008 and 2019. Risk stratification at diagnosis was performed according to the definition suggested by the ongoing AML 2012 study in Korea, and the clinical factors associated with prognosis were analyzed. Results A total of 27 pediatric patients with relapsed AML were identified. The 5-year overall survival (OS) and event-free survival (EFS) rates were 32.9% and 32.9%, respectively. A duration ≥12 months from diagnosis to relapse had a favorable impact on survival outcomes (5-yr OS, 64.0% vs. 15.7%; P=0.007). Patients who achieved complete remission (CR) after 1 course of chemotherapy following relapse (N=15) had a 5-year OS rate of 59.3%, while none of the other patients survived (P<0.0001). Additionally, the 5-year OS differed significantly based on the risk group at initial diagnosis (62.3% [favorable and intermediate prognosis groups, N=11] vs. 13.3% [poor prognosis group, N=15]; P=0.014). Conclusion Patients with a longer duration of CR before relapse, who achieved CR following 1 course of reinduction chemotherapy, and were in the favorable or intermediate prognosis group at diagnosis demonstrated better outcomes. These findings emphasize the importance of tailoring treatment strategies based on the expected prognosis at relapse in pediatric patients with AML.
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Affiliation(s)
- Jung Hwan Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Kyung Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cell & Gene Therapy Institute, Samsung Medical Center, Seoul, Korea
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3
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Egan G, Tasian SK. Relapsed pediatric acute myeloid leukaemia: state-of-the-art in 2023. Haematologica 2023; 108:2275-2288. [PMID: 36861399 PMCID: PMC10483345 DOI: 10.3324/haematol.2022.281106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Although outcomes of children and adolescents with newly diagnosed acute myeloid leukemia (AML) have improved significantly over the past two decades, more than one-third of patients continue to relapse and experience suboptimal long-term outcomes. Given the small numbers of patients with relapsed AML and historical logistical barriers to international collaboration including poor trial funding and drug availability, the management of AML relapse has varied among pediatric oncology cooperative groups with several salvage regimens utilized and a lack of universally defined response criteria. The landscape of relapsed pediatric AML treatment is changing rapidly, however, as the international AML community harnesses collective knowledge and resources to characterize the genetic and immunophenotypic heterogeneity of relapsed disease, identify biological targets of interest within specific AML subtypes, develop new precision medicine approaches for collaborative investigation in early-phase clinical trials, and tackle challenges of universal drug access across the globe. This review provides a comprehensive overview of progress achieved to date in the treatment of pediatric patients with relapsed AML and highlights modern, state-of-the-art therapeutic approaches under active and emerging clinical investigation that have been facilitated by international collaboration among academic pediatric oncologists, laboratory scientists, regulatory agencies, pharmaceutical partners, cancer research sponsors, and patient advocates.
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Affiliation(s)
- Grace Egan
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto; Toronto, Ontario
| | - Sarah K Tasian
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Pennsylvania, United States; University of Pennsylvania Perelman School of Medicine and Abramson Cancer Center; Philadelphia, Pennsylvania.
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Songthawee N, Sripornsawan P, Chavananon S, McNeil EB, Chotsampancharoen T. Relapsed Childhood Acute Myeloid Leukemia: Experience from a Single Tertiary Center in Thailand. Asian Pac J Cancer Prev 2022; 23:4079-4084. [PMID: 36579988 PMCID: PMC9971450 DOI: 10.31557/apjcp.2022.23.12.4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have examined survival outcomes in relapsed childhood acute myeloid leukemia (AML) in resource-limited countries. This study aimed to evaluate the prognostic factors and survival outcomes of relapsed childhood AML in Thailand. METHODS The medical records of AML patients aged 0-15 years treated in a major tertiary center in Southern Thailand between December 1979 and December 2019 were reviewed retrospectively. The overall survival (OS) was calculated using the Kaplan-Meier method. RESULTS A total of 316 AML patients were included and relapse occurred in 98 (31%) patients. Of these, 57 (58.2%) and 41 (41.8%) patients had early [≤1 year from first complete remission (CR1)] and late (>1 year from CR1) relapses, respectively. Only 54 (55.1%) patients received chemotherapy after relapse. The 3-year OS of all relapsed patients was 3.5%. The 3-year OS of patients with early and late relapse were 0% and 8.5%, respectively (p=0.002). The 3-year OS of patients who received chemotherapy and those who did not were 6.5% and 0%, respectively (p <0.0001). The median survival time of patients who did not receive chemotherapy was 1.7 months. The 3-year OS of patients who achieved second complete remission (CR2) and those who did not were 12.6% and 0%, respectively (p <0.001). CONCLUSION The relapsed AML rate was 31% and the survival outcome was poor with a 3-year OS of 3.5%. The adverse prognostic factors were early relapse, failure to achieve CR2 and those who did not receive chemotherapy after relapse.
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Affiliation(s)
- Natsaruth Songthawee
- Department of Pediatrics, Division of Hematology and Oncology, Prince of Songkla University, Hat Yai, Thailand.
| | - Pornpun Sripornsawan
- Department of Pediatrics, Division of Hematology and Oncology, Prince of Songkla University, Hat Yai, Thailand.
| | - Shevachut Chavananon
- Department of Pediatrics, Division of Hematology and Oncology, Prince of Songkla University, Hat Yai, Thailand.
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
| | - Thirachit Chotsampancharoen
- Department of Pediatrics, Division of Hematology and Oncology, Prince of Songkla University, Hat Yai, Thailand. ,For Correspondence:
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Zhang H, Bu C, Peng Z, Li G, Zhou Z, Ding W, Zheng Y, He Y, Hu Z, Pei K, Luo M, Li C. Characteristics of anti-CLL1 based CAR-T therapy for children with relapsed or refractory acute myeloid leukemia: the multi-center efficacy and safety interim analysis. Leukemia 2022; 36:2596-2604. [PMID: 36151140 DOI: 10.1038/s41375-022-01703-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
C-type lectin-like molecule-1 (CLL1) is preferentially expressed on acute myeloid leukemia (AML) stem cells and AML blasts, which can be considered as AML-associated antigen. Anti-CLL1-based CAR-T cells exhibited effective tumor-killing capacity in vitro and in AML-bearing mouse model. In this report, eight children with relapsed or refractory AML (R/R-AML) were recruited for a phase 1/2 clinical trial of autologous anti-CLL1 CAR-T cell immunotherapy. The objectives of this clinical trial were to evaluate the safety and the preliminary efficacy of anti-CLL1 CAR-T cell treatment. Patients received one dose of autologous anti-CLL1 CAR-T cells after lymphodepletion conditioning. After CAR-T treatment, patients developed grade 1-2 cytokine release syndrome (CRS) but without any lethal events. 4 out of 8 patients achieved morphologic leukemia-free state (MLFS) and minimal residual disease (MRD) negativity, 1 patient with MLFS and MRD positivity, 1 patient achieved complete remission with incomplete hematologic recovery (CRi) but MRD positivity, 1 patient with partial remission (PR), and 1 patient remained at stable disease (SD) status but had CLL1-positive AML blast clearance. These results suggested that anti-CLL1-based CAR-T cell immunotherapy can be considered as a well-tolerated and effective option for treating children with R/R-AML.
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Affiliation(s)
- Hui Zhang
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China.,Department of Hematology/Oncology, Shanghai Jiaotong University School of Medicine Affiliated Shanghai Children's Medical Center, Shanghai, China
| | - Chaoke Bu
- Nanfang-Chunfu Children's Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China
| | - Zhiyong Peng
- Nanfang-Chunfu Children's Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China
| | - Guangchao Li
- Guangzhou Bio-Gene Technology Co., Ltd, Guangzhou, China
| | - Zhao Zhou
- Guangzhou Bio-Gene Technology Co., Ltd, Guangzhou, China
| | - Wen Ding
- Guangzhou Bio-Gene Technology Co., Ltd, Guangzhou, China
| | - Yongwei Zheng
- Guangzhou Bio-Gene Technology Co., Ltd, Guangzhou, China
| | - Yingyi He
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhengbin Hu
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Kunlin Pei
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Min Luo
- Guangzhou Bio-Gene Technology Co., Ltd, Guangzhou, China.
| | - Chunfu Li
- Nanfang-Chunfu Children's Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China.
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White T, Kaspers G, Abrahamsson J, Arad-Cohen N, Cianci D, Fernandez J, Ha SY, Hasle H, De Moerloose B, Zwaan CM, Goemans BF. Clinical outcomes of second relapsed and refractory first relapsed paediatric AML: A retrospective study within the NOPHO-DB SHIP consortium. Br J Haematol 2022; 197:755-765. [PMID: 35118649 PMCID: PMC9303517 DOI: 10.1111/bjh.18039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023]
Abstract
As treatments for second relapsed and refractory first relapsed paediatric AML transition from purely palliative to more commonly curative in nature, comparative data is necessary for evaluating the effectiveness of emerging treatment options. Furthermore, little is known about predictors of prognosis following third-line therapy. From 2004 until 2019, 277 of the 869 patients enrolled in NOPHO-DB SHIP consortium trials experienced a first relapse and, of these patients, 98 experienced refractory first relapse and 59 a second relapse. Data on patient and disease characteristics within this cohort of 157 patients was analysed to determine probability of overall survival (pOS) and to identify factors influencing survival. Data on early treatment response and complete remission were not available. One and 5-year pOS were 22 ± 3% and 14 ± 3%, respectively. There was no statistically significant difference in survival between refractory first relapsed and second relapsed AML. Factors influencing prognosis included: late relapse, type of third-line treatment, FLT3 mutational status, and original treatment protocol. These data provide a baseline for evaluating the effectiveness of emerging therapies for the treatment of children with refractory first relapsed and second relapsed paediatric AML and evidence that select patients receiving third-line therapy can be cured.
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Affiliation(s)
- Tara White
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Vrije Universiteit, Amsterdam, The Netherlands.,Dutch Childhood Oncology Group (DCOG), Utrecht, The Netherlands
| | - Jonas Abrahamsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Nira Arad-Cohen
- Pediatric Hemato-Oncology Department, Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Daniela Cianci
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jose Fernandez
- Pediatric Oncology and Haematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Shau-Yin Ha
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children 's Hospital, Ngau Tau Kok, Hong Kong
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bianca F Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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7
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Klein K, Beverloo HB, Zimmermann M, Raimondi SC, von Neuhoff C, de Haas V, van Weelderen R, Cloos J, Abrahamsson J, Bertrand Y, Dworzak M, Fynn A, Gibson B, Ha SY, Harrison CJ, Hasle H, Elitzur S, Leverger G, Maschan A, Razzouk B, Reinhardt D, Rizzari C, Smisek P, Creutzig U, Kaspers GJL. Prognostic significance of chromosomal abnormalities at relapse in children with relapsed acute myeloid leukemia: A retrospective cohort study of the Relapsed AML 2001/01 Study. Pediatr Blood Cancer 2022; 69:e29341. [PMID: 34532968 DOI: 10.1002/pbc.29341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In addition to treatment response, cytogenetic and molecular aberrations are the most important prognostic factors in children with de novo acute myeloid leukemia (AML). However, little is known about cytogenetics at the time of relapse. METHODS This international study analyzed the prognostic value of cytogenetic profiles and karyotypic changes in pediatric relapsed AML in relation to the probability of event-free (pEFS) and overall survival (pOS). For this purpose, cytogenetic reports from all patients registered on the Relapsed AML 2001/01 Study were reviewed and classified. RESULTS Cytogenetic information at relapse was available for 403 (71%) of 569 registered patients. Frequently detected aberrations at relapse were t(8;21)(q22;q22) (n = 60) and inv(16)(p13.1q22)/t(16;16)(p13.1;q22) (n = 24), both associated with relatively good outcome (4-year pOS 59% and 71%, respectively). Monosomy 7/7q-, t(9;11)(p22;q23), t(10;11)(p12;q23), and complex karyotypes were associated with poor outcomes (4-year pOS 17%, 19%, 22%, and 22%, respectively). Of 261 (65%) patients for whom cytogenetic data were reliable at both diagnosis and relapse, pEFS was inferior for patients with karyotypic instability (n = 128, 49%), but pOS was similar. Unstable karyotypes with both gain and loss of aberrations were associated with inferior outcome. Early treatment response, time to relapse, and cytogenetic profile at time of relapse were the most important prognostic factors, both outweighing karytoypic instability per se. CONCLUSION The cytogenetic subgroup at relapse is an independent risk factor for (event-free) survival. Cytogenetic assessment at the time of relapse is of high importance and may contribute to improved risk-adapted treatment for children with relapsed AML.
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Affiliation(s)
- Kim Klein
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Martin Zimmermann
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Susana C Raimondi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christine von Neuhoff
- Department of Pediatric Hematology-Oncology, University Hospital Essen, Essen, Germany
| | - Valérie de Haas
- Clinical laboratory, Dutch Childhood Oncology Group, The Hague, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Romy van Weelderen
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jacqueline Cloos
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonas Abrahamsson
- Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Yves Bertrand
- Children's Leukemia Cooperative Group/European Organisation for Research and Treatment of Cancer, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Alcira Fynn
- Grupo Argentino de Tratamiento de la Leucemia Aguda, Children's Hospital La Plata, La Plata, Buenos Aires, Argentina
| | - Brenda Gibson
- Department of Paediatric Haematology, United Kingdom Childhood Leukaemia Study Group, Royal Hospital for Children, Glasgow, UK
| | - Shau-Yin Ha
- Department of Pediatrics/Pediatric oncology, Hong Kong Children's Hospital, Hong Kong, China
| | - Christine J Harrison
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Sarah Elitzur
- Schneider Children's Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Leverger
- Hematopathology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Alexei Maschan
- Oncology and Immunology, Dmitriy Rogachev Federal Center for Pediatric Hematology, Moscow, Russia
| | - Bassem Razzouk
- Children's Center for Cancer and Blood Diseases, Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University Hospital Essen, Essen, Germany
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Pter Smisek
- Department of Pediatric Hematology and Oncology, Carles University in Prague/Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Gertjan J L Kaspers
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Clinical laboratory, Dutch Childhood Oncology Group, The Hague, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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8
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van Tilburg CM, Pfaff E, Pajtler KW, Langenberg KP, Fiesel P, Jones BC, Balasubramanian GP, Stark S, Johann PD, Blattner-Johnson M, Schramm K, Dikow N, Hirsch S, Sutter C, Grund K, von Stackelberg A, Kulozik AE, Lissat A, Borkhardt A, Meisel R, Reinhardt D, Klusmann JH, Fleischhack G, Tippelt S, von Schweinitz D, Schmid I, Kramm CM, von Bueren AO, Calaminus G, Vorwerk P, Graf N, Westermann F, Fischer M, Eggert A, Burkhardt B, Wößmann W, Nathrath M, Hecker-Nolting S, Frühwald MC, Schneider DT, Brecht IB, Ketteler P, Fulda S, Koscielniak E, Meister MT, Scheer M, Hettmer S, Schwab M, Tremmel R, Øra I, Hutter C, Gerber NU, Lohi O, Kazanowska B, Kattamis A, Filippidou M, Goemans B, Zwaan CM, Milde T, Jäger N, Wolf S, Reuss D, Sahm F, von Deimling A, Dirksen U, Freitag A, Witt R, Lichter P, Kopp-Schneider A, Jones DT, Molenaar JJ, Capper D, Pfister SM, Witt O. The Pediatric Precision Oncology INFORM Registry: Clinical Outcome and Benefit for Patients with Very High-Evidence Targets. Cancer Discov 2021; 11:2764-2779. [PMID: 34373263 PMCID: PMC9414287 DOI: 10.1158/2159-8290.cd-21-0094] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 01/26/2023]
Abstract
INFORM is a prospective, multinational registry gathering clinical and molecular data of relapsed, progressive, or high-risk pediatric patients with cancer. This report describes long-term follow-up of 519 patients in whom molecular alterations were evaluated according to a predefined seven-scale target prioritization algorithm. Mean turnaround time from sample receipt to report was 25.4 days. The highest target priority level was observed in 42 patients (8.1%). Of these, 20 patients received matched targeted treatment with a median progression-free survival of 204 days [95% confidence interval (CI), 99-not applicable], compared with 117 days (95% CI, 106-143; P = 0.011) in all other patients. The respective molecular targets were shown to be predictive for matched treatment response and not prognostic surrogates for improved outcome. Hereditary cancer predisposition syndromes were identified in 7.5% of patients, half of which were newly identified through the study. Integrated molecular analyses resulted in a change or refinement of diagnoses in 8.2% of cases. SIGNIFICANCE: The pediatric precision oncology INFORM registry prospectively tested a target prioritization algorithm in a real-world, multinational setting and identified subgroups of patients benefiting from matched targeted treatment with improved progression-free survival, refinement of diagnosis, and identification of hereditary cancer predisposition syndromes.See related commentary by Eggermont et al., p. 2677.This article is highlighted in the In This Issue feature, p. 2659.
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Affiliation(s)
- Cornelis M. van Tilburg
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Corresponding Author: Cornelis M. van Tilburg, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg 69120, Germany. Phone: 00-49-6221-56-36926; E-mail:
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristian W. Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Petra Fiesel
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Barbara C. Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gnana Prakash Balasubramanian
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Stark
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pascal D. Johann
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | - Mirjam Blattner-Johnson
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kathrin Schramm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Hirsch
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Sutter
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Kerstin Grund
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Arend von Stackelberg
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Oncology and Hematology Department, Charité–Campus Virchow Klinikum, Berlin, Germany
| | - Andreas E. Kulozik
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Clinical Cooperation Unit Pediatric Leukemia, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrej Lissat
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Oncology and Hematology Department, Charité–Campus Virchow Klinikum, Berlin, Germany
| | - Arndt Borkhardt
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology and Hematology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Roland Meisel
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dirk Reinhardt
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Jan-Henning Klusmann
- Department of Pediatric Hematology, Oncology and Hemostaseology, Clinic for Pediatrics, University Hospital of Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Gudrun Fleischhack
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Stephan Tippelt
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Dietrich von Schweinitz
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Irene Schmid
- Department of Pediatric Oncology and Hematology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christof M. Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - André O. von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Gabriele Calaminus
- Department of Pediatric Oncology and Hematology, University Hospital Bonn, Bonn, Germany
| | - Peter Vorwerk
- Department of Pediatric Oncology and Hematology, University Hospital Magdeburg, Magdeburg, Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, University Hospital Saarland, Saarland, Germany
| | - Frank Westermann
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Fischer
- National Center for Tumor Diseases (NCT) Network, Germany.,Department of Experimental Pediatric Oncology, University Hospital Köln, and Center for Molecular Medicine (CMMC), Medical Faculty, Cologne, Germany
| | - Angelika Eggert
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Oncology and Hematology Department, Charité–Campus Virchow Klinikum, Berlin, Germany
| | - Birgit Burkhardt
- Clinic of Pediatric Oncology and Hematology, University Hospital Münster, Muenster, Germany
| | - Wilhelm Wößmann
- Department of Pediatric Oncology and Hematology, University Hospital Hamburg, Hamburg, Germany
| | - Michaela Nathrath
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.,Department of Pediatrics, Technical University Munich, Munich, Germany
| | - Stefanie Hecker-Nolting
- National Center for Tumor Diseases (NCT) Network, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Michael C. Frühwald
- National Center for Tumor Diseases (NCT) Network, Germany.,Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | | | - Ines B. Brecht
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Tübingen, Tübingen, Germany
| | - Petra Ketteler
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Simone Fulda
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Institute for Experimental Cancer Research in Pediatrics, Goethe University Frankfurt, Frankfurt, Germany
| | - Ewa Koscielniak
- National Center for Tumor Diseases (NCT) Network, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Michael T. Meister
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Monika Scheer
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Oncology and Hematology Department, Charité–Campus Virchow Klinikum, Berlin, Germany
| | - Simone Hettmer
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Schwab
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,Departments of Clinical Pharmacology, Pharmacy and Biochemistry, and Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tübingen, Tübingen, Germany
| | - Roman Tremmel
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Ingrid Øra
- Department of Pediatric Oncology and Hematology, Skane University Hospital Lund, and HOPE-ITCC Unit, Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Hutter
- St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, and St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Nicolas U. Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Olli Lohi
- Tampere Center for Child Health Research and Tays Cancer Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bernarda Kazanowska
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Filippidou
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Bianca Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - C. Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephan Wolf
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uta Dirksen
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ruth Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany
| | - Peter Lichter
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annette Kopp-Schneider
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Department Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T.W. Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan J. Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Utrecht University, Department of Pharmaceutical Sciences, Utrecht, the Netherlands
| | - David Capper
- German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Stefan M. Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Network, Germany
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9
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Survival Following Relapse in Children with Acute Myeloid Leukemia: A Report from AML-BFM and COG. Cancers (Basel) 2021; 13:cancers13102336. [PMID: 34066095 PMCID: PMC8151466 DOI: 10.3390/cancers13102336] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Acute myeloid leukemia in children remains a difficult disease to cure despite intensive therapies that push the limits of tolerability. Though the intent of initial therapy should be the prevention of relapse, about 30% of all patients experience a relapse. Hence, relapse therapy remains critically important for survival. This retrospective analysis of two large international study groups (COG and BFM) was undertaken to describe the current survival, response rates and clinical features that predict outcomes. We demonstrate that children with relapsed AML may be cured with cytotoxic therapy followed by HSCT. High-risk features at initial diagnosis and early relapse remain prognostic for post-relapse survival. Current response criteria are not aligned with the standards of care for children, nor are the count recovery thresholds meaningful for prognosis in children with relapsed AML. Our data provide a new baseline for future treatment planning and will allow an updated stratification in upcoming studies. Abstract Post-relapse therapy remains critical for survival in children with acute myeloid leukemia (AML). We evaluated survival, response and prognostic variables following relapse in independent cooperative group studies conducted by COG and the population-based AML-BFM study group. BFM included 197 patients who relapsed after closure of the last I-BFM relapse trial until 2017, while COG included 852 patients who relapsed on the last Phase 3 trials (AAML0531, AAML1031). Overall survival at 5 years (OS) was 42 ± 4% (BFM) and 35 ± 2% (COG). Initial high-risk features (BFM 32 ± 6%, COG 26 ± 4%) and short time to relapse (BFM 29 ± 4%, COG 25 ± 2%) predicted diminished survival. In the BFM dataset, there was no difference in OS for patients who had a complete remission with full hematopoietic recovery (CR) following post-relapse re-induction compared to those with partial neutrophil and platelet recovery (CRp and CRi) only (52 ± 7% vs. 63 ± 10%, p = 0.39). Among 90 patients alive at last follow-up, 87 had received a post-relapse hematopoietic stem cell transplant (HSCT). OS for patients with post-relapse HSCT was 54 ± 4%. In conclusion, initial high-risk features and early relapse remain prognostic. Response assessment with full hematopoietic recovery following initial relapse therapy does not predict survival. These data indicate the need for post-relapse risk stratification in future studies of relapse therapies.
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10
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Second Relapse of Pediatric Patients with Acute Myeloid Leukemia: A Report on Current Treatment Strategies and Outcome of the AML-BFM Study Group. Cancers (Basel) 2021; 13:cancers13040789. [PMID: 33672815 PMCID: PMC7918758 DOI: 10.3390/cancers13040789] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Children with acute myeloid leukemia (AML) experience high relapse rates of about 30%; still, survival rates following the first relapse are encouraging. Hence, it is critically important to examine the consequences of a second relapse; however, little is known about this subgroup of patients. This retrospective population-based analysis intends to describe response, survival and prognostic factors relevant for the survival of children with second relapse of AML. Treatment approaches include many different therapeutic regimens, including palliation and intensive treatment with curative intent (63% of the patients). Survival is poor; however, patients who respond to reinduction attempts can be rescued with subsequent hematopoietic stem cell transplantation. We deciphered risk factors, such as short time interval from first to second relapse below one year as being associated with a poor outcome. This analysis will help to improve future international treatment planning and patient care of children with advanced AML. Abstract Successful management of relapse is critical to improve outcomes of children with acute myeloid leukemia (AML). We evaluated response, survival and prognostic factors after a second relapse of AML. Among 1222 pediatric patients of the population-based AML-Berlin–Frankfurt–Munster (BFM) study group (2004 until 2017), 73 patients met the quality parameters for inclusion in this study. Central review of source documentation warranted the accuracy of reported data. Treatment approaches included palliation in 17 patients (23%), intensive therapy with curative intent (n = 46, 63%) and other regimens (n = 10). Twenty-five patients (35%) received hematopoietic stem cell transplantation (HSCT), 21 of whom (88%) had a prior HSCT. Survival was poor, with a five-year probability of overall survival (pOS) of 15 ± 4% and 31 ± 9% following HSCT (n = 25). Early second relapse (within one year after first relapse) was associated with dismal outcome (pOS 2 ± 2%, n = 44 vs. 33 ± 9%, n = 29; p < 0.0001). A third complete remission (CR) is required for survival: 31% (n = 14) of patients with intensive treatment achieved a third CR with a pOS of 36 ± 13%, while 28 patients (62%) were non-responders (pOS 7 ± 5%). In conclusion, survival is poor but possible, particularly after a late second relapse and an intensive chemotherapy followed by HSCT. This analysis provides a baseline for future treatment planning.
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11
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Hoffman AE, Schoonmade LJ, Kaspers GJ. Pediatric relapsed acute myeloid leukemia: a systematic review. Expert Rev Anticancer Ther 2020; 21:45-52. [PMID: 33111585 DOI: 10.1080/14737140.2021.1841640] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Pediatric relapsed acute myeloid leukemia (AML) remains lethal in the majority of cases, despite intensive therapy. Randomized trials are largely lacking, and the main issues of optimal therapy and prognostic factors remain unclear. Area covered: This systematic review includes all literature evaluating treatment outcome after first relapse. We searched databases PubMed and Embase.com. Twelve out of six thousand articles were ultimately included, based on age of the population (<21 years), relapsed AML, and information on clinical outcome (second complete remission (CR2), disease-free survival (DFS), event-free survival (EFS) and overall survival (OS)). There was only one randomized clinical trial reported. This review shows that there is no standard treatment for relapsed AML in children, and that outcome varies for CR2 and (2- to 10-year) OS rates, mean 64% (range, 50-75%), and 31% (16-43%), respectively. Children treated with chemotherapy only in first complete remission (CR1) tend to have better outcome after relapse than children receiving allo-SCT in CR1. Allo-SCT seems to be the most effective consolidation therapy in children achieving CR2, after relapse. Duration of CR1 was the most frequently reported statistically significant prognostic factor. Through randomized clinical trials, better knowledge of prognostic factors enabling risk-stratified treatment, and of more effective and less toxic therapies, should contribute to better clinical outcome for children with relapsed AML. Expert opinion: Outcome of pediatric relapsed AML has improved to OS rates up to 40%. However, there is a lack of knowledge on (independent) prognostic factors, optimal reinduction chemotherapy, timing of allo-SCT, and late effects. International collaboration should enable large, randomized clinical trials addressing these issues.
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Affiliation(s)
- Anne E Hoffman
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam , Amsterdam
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | - Gertjan Jl Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam , Amsterdam.,Princess Máxima Center For Pediatric Oncolocy , The Netherlands, Utrecht
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12
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Garg A, Ganguly S, Vishnubhatla S, Chopra A, Bakhshi S. Outpatient ADE (cytarabine, daunorubicin, and etoposide) is feasible and effective for the first relapse of pediatric acute myeloid leukemia: A prospective, phase II study. Pediatr Blood Cancer 2020; 67:e28404. [PMID: 32672904 DOI: 10.1002/pbc.28404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/26/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Approximately 40% children with acute myeloid leukemia (AML) invariably relapse, after attaining the first complete remission (CR), with dismal long-term outcome. There is little consensus regarding choice of optimal induction chemotherapy regimen for relapsed pediatric AML. PROCEDURE A prospective single arm phase II study (CTRI/2017/02/007757) was carried out at our center to evaluate the safety and efficacy of outpatient cytarabine, daunorubicin, and etoposide (ADE) regimen in pediatric AML (≤18 years) at the first relapse. Response evaluation was done by bone marrow aspiration morphology along with minimal residual disease (MRD) assessment. All adverse events including need and duration of hospitalization, transfusion support, and antimicrobial use were recorded. RESULTS Total 45 patients were included with median age of 12 years. The CR rate of the cohort was 66% and 54% of patients were MRD negative. The estimated 2-year event-free survival (EFS) and overall survival (OS) were 29% (±7%) and 34% (±7%), respectively. The presence of fever at relapse was associated with inferior CR rate (P = .001), positive MRD (P = .01), and inferior EFS (P = .02), while not achieving nadir absolute neutrophil count of zero during induction was associated with inferior CR rate (P = .03) and inferior OS (P = .04). Approximately all patients developed ≥Grade 3 cytopenia and febrile neutropenia. Twenty-six (59%) patients required hospitalization for management of toxicity and there were four (9%) deaths attributed to infection. CONCLUSION ADE is an effective induction regimen for pediatric AML patients at the first relapse with reasonable toxicity profile. Outpatient administration of the regimen is feasible in the presence of proper support structure and rigorous follow up.
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Affiliation(s)
- Arun Garg
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Chopra
- Department of Laboratory Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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13
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Hu GH, Cheng YF, Lu AD, Wang Y, Zuo YX, Yan CH, Wu J, Sun YQ, Suo P, Chen YH, Chen H, Jia YP, Liu KY, Han W, Xu LP, Zhang LP, Huang XJ. Allogeneic hematopoietic stem cell transplantation can improve the prognosis of high-risk pediatric t(8;21) acute myeloid leukemia in first remission based on MRD-guided treatment. BMC Cancer 2020; 20:553. [PMID: 32539815 PMCID: PMC7294617 DOI: 10.1186/s12885-020-07043-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) with t(8;21) (q22;q22) is classified as a low-risk group. However, relapse is still the main factor affecting survival. We aimed to investigate the effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on reducing recurrence and improving the survival of high-risk pediatric t(8;21) AML based on minimal residual disease (MRD)-guided treatment, and to further explore the prognostic factors to guide risk stratification treatment and identify who will benefit from allo-HSCT. Methods Overall, 129 newly diagnosed pediatric t(8;21) AML patients were included in this study. Patients were divided into high-risk and low-risk group according to RUNX1-RUNX1T1 transcript levels after 2 cycles of consolidation chemotherapy. High-risk patients were divided into HSCT group and chemotherapy group according to their treatment choices. The characteristics and outcomes of 125 patients were analyzed. Results For high-risk patients, allo-HSCT could improve 5-year relapse-free survival (RFS) rate compared to chemotherapy (87.4% vs. 61.9%; P = 0.026). Five-year overall survival (OS) rate in high-risk HSCT group had a trend for better than that in high-risk chemotherapy group (82.8% vs. 71.4%; P = 0.260). The 5-year RFS rate of patients with a c-KIT mutation in high-risk HSCT group had a trend for better than that of patients with a c-KIT mutation in high-risk chemotherapy group (82.9% vs. 75%; P = 0.400). Extramedullary infiltration (EI) at diagnosis was associated with a high cumulative incidence of relapse for high-risk patients (50% vs. 18.4%; P = 0.004); allo-HSCT can improve the RFS (P = 0.009). Conclusions allo-HSCT can improve the prognosis of high-risk pediatric t(8;21) AML based on MRD-guided treatment. Patients with a c-KIT mutation may benefit from allo-HSCT. EI is an independent prognostic factor for high-risk patients and allo-HSCT can improve the prognosis.
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Affiliation(s)
- Guan-Hua Hu
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yi-Fei Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Ai-Dong Lu
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Ying-Xi Zuo
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Jun Wu
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Pan Suo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yue-Ping Jia
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Le-Ping Zhang
- Department of Pediatrics, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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14
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van Tilburg CM, Witt R, Heiss M, Pajtler KW, Plass C, Poschke I, Platten M, Harting I, Sedlaczek O, Freitag A, Meyrath D, Taylor L, Balasubramanian GP, Jäger N, Pfaff E, Jones BC, Milde T, Pfister SM, Jones DTW, Kopp-Schneider A, Witt O. INFORM2 NivEnt: The first trial of the INFORM2 biomarker driven phase I/II trial series: the combination of nivolumab and entinostat in children and adolescents with refractory high-risk malignancies. BMC Cancer 2020; 20:523. [PMID: 32503469 PMCID: PMC7275428 DOI: 10.1186/s12885-020-07008-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pediatric patients with relapsed or refractory disease represent a population with a desperate medical need. The aim of the INFORM (INdividualized Therapy FOr Relapsed Malignancies in Childhood) program is to translate next generation molecular diagnostics into a biomarker driven treatment strategy. The program consists of two major foundations: the INFORM registry providing a molecular screening platform and the INFORM2 series of biomarker driven phase I/II trials. The INFORM2 NivEnt trial aims to determine the recommended phase 2 dose (RP2D) of the combination treatment of nivolumab and entinostat (phase I) and to evaluate activity and safety (phase II). Methods This is an exploratory non-randomized, open-label, multinational and multicenter seamless phase I/II trial in children and adolescents with relapsed / refractory or progressive high-risk solid tumors and CNS tumors. The phase I is divided in 2 age cohorts: 12–21 years and 6–11 years and follows a 3 + 3 design with two dose levels for entinostat (2 mg/m2 and 4 mg/m2 once per week) and fixed dose nivolumab (3 mg/kg every 2 weeks). Patients entering the trial on RP2D can seamlessly enter phase II which consists of a biomarker defined four group basket trial: high mutational load (group A), high PD-L1 mRNA expression (group B), focal MYC(N) amplification (group C), low mutational load and low PD-L1 mRNA expression and no MYC(N) amplification (group D). A Bayesian adaptive design will be used to early stop cohorts that fail to show evidence of activity. The maximum number of patients is 128. Discussion This trial intends to exploit the immune enhancing effects of entinostat on nivolumab using an innovative biomarker driven approach in order to maximize the chance of detecting signs of activity. It prevents exposure to unnecessary risks by applying the Bayesian adaptive design for early stopping for futility. The adaptive biomarker driven design provides an innovative approach accelerating drug development and reducing exposure to investigational treatments in these vulnerable children at the same time. Trial registration ClinicalTrials.gov, NCT03838042. Registered on 12 February 2019.
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Affiliation(s)
- Cornelis M van Tilburg
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany. .,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Ruth Witt
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Melanie Heiss
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kristian W Pajtler
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christoph Plass
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabel Poschke
- DKTK Immune Monitoring Unit, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Platten
- DKTK Immune Monitoring Unit, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,DKTK CCU Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Sedlaczek
- Radiology Cooperation Uni/DKFZ, Division of Radiology, NCT, Heidelberg, Germany
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Meyrath
- Pharmacy Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Lenka Taylor
- Pharmacy Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Gnana Prakash Balasubramanian
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Barbara C Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Till Milde
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - David T W Jones
- Pediatric Glioma Research Group, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Olaf Witt
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
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15
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Osman SH, Abu N, Aziz H, Chow YP, Wan Mohamad Nazarie WF, Ab Mutalib NS, Alias H, Jamal R. Deep Transcriptome Sequencing of Pediatric Acute Myeloid Leukemia Patients at Diagnosis, Remission and Relapse: Experience in 3 Malaysian Children in a Single Center Study. Front Genet 2020; 11:66. [PMID: 32174960 PMCID: PMC7056821 DOI: 10.3389/fgene.2020.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/20/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Siti Hawa Osman
- UKM Medical Molecular Biology Institute, The National University of Malaysia, Cheras, Malaysia
| | - Nadiah Abu
- UKM Medical Molecular Biology Institute, The National University of Malaysia, Cheras, Malaysia
| | - Habsah Aziz
- UKM Medical Molecular Biology Institute, The National University of Malaysia, Cheras, Malaysia
| | - Yock Ping Chow
- UKM Medical Molecular Biology Institute, The National University of Malaysia, Cheras, Malaysia
| | | | | | - Hamidah Alias
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
- *Correspondence: Hamidah Alias, ; Rahman Jamal,
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute, The National University of Malaysia, Cheras, Malaysia
- *Correspondence: Hamidah Alias, ; Rahman Jamal,
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16
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Ciftciler R, Haznedaroglu IC, Ozcebe O, Aksu S, Sayınalp N, Goker H, Demiroglu H, Buyukasık Y. The comparison of bone marrow kinetics between patients with acute myeloid leukemia and acute promyelocytic leukemia after induction chemotherapy. Immunopharmacol Immunotoxicol 2019; 42:17-21. [PMID: 31744339 DOI: 10.1080/08923973.2019.1692865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Aim: Recently, acute promyelocytic leukemia (APL) has shifted from the most hazardous to the best curable type of acute myeloid leukemia. Anthracyclines, all-trans retinoic acid (ATRA) and arsenic derivatives are the most important developments for the treatment of APL. ATRA promotes the terminal differentiation of malignant promyelocytes to mature neutrophils. We aimed to compare platelet and neutrophil recovery time after induction chemotherapy in patients with acute myeloid leukemia (AML) and APL.Materials and Methods: Two hundred and fifteen patients with AML and APL, who were diagnosed and treated in our tertiary care center between the years of 2001 and 2018 were evaluated.Results: One hundred and eighty one AML patients (84.2%) and 34 (15.8%) APL patients were included in this study. The time between neutrophil nadir after induction chemotherapy and neutrophil recovery was longer in APL patients than in AML patients [30.5 (4-52) vs. 20 (5-58), p < 0.001]. The time between platelet nadir after induction chemotherapy and platelet recovery was longer in APL patients than in AML patients [21.5 (4-42) vs. 17 (4-45), p = 0.02].Conclusion: Neutrophil and platelet recovery times were longer in APL patients than in AML patients in our present study. In 60 days, mortality rate was higher in APL patients than AML patients. Non-relapse mortality (NRM) rate was similar between two groups. There was a significant difference between two groups in terms of NRM causes. Platelet and neutrophil recovery time is very important because infection is the most important cause of NRM.
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Affiliation(s)
- Rafiye Ciftciler
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Osman Ozcebe
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Salih Aksu
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Sayınalp
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hakan Goker
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Haluk Demiroglu
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yahya Buyukasık
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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17
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Çiftçiler R, Haznedaroğlu İC, Sayınalp N, Özcebe O, Aksu S, Demiroğlu H, Göker H, Malkan ÜY, Büyükaşık Y. The Impact of Early Versus Late Platelet and Neutrophil Recovery after Induction Chemotherapy on Survival Outcomes of Patients with Acute Myeloid Leukemia. Turk J Haematol 2019; 37:116-120. [PMID: 31475513 PMCID: PMC7236414 DOI: 10.4274/tjh.galenos.2019.2019.0154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The prognosis of patients with acute myeloid leukemia (AML) is affected by factors that are both patient- and disease-specific. The aim of this study is to evaluate the impact of early versus late platelet and neutrophil recovery after induction chemotherapy on survival outcomes of AML patients. Materials and Methods: A total of 181 patients with AML who were treated in our tertiary center between 2001 and 2018 were evaluated. Neutrophil and platelet recovery times were accepted as the periods from the beginning of induction chemotherapy to a neutrophil count of ≥0.5x109/L and a platelet count of ≥20x109/L 3 days in a row, respectively. The median time to platelet recovery was 25 days (range=12-52) for all patients. Therefore, platelet recovery in the first 25 days was defined as early platelet recovery (EPR) and at ≥26 days it was defined as late platelet recovery (LPR). The median time to neutrophil recovery was 28 days (range=13-51) for all patients. Therefore, neutrophil recovery in the first 28 days was defined as early neutrophil recovery, and at ≥29 days it was defined as late neutrophil recovery. Results: The 5-year overall survival (OS) rates for patients who had EPR and LPR after induction chemotherapy were 62% and 23%, respectively (p<0.001). The 5-year disease-free survival (DFS) rates for patients who had EPR and LPR after induction chemotherapy were 57% and 15%, respectively (p<0.001). Conclusion: Short bone marrow recovery time may indicate better healthy hematopoiesis and marrow capacity associated with longer OS and DFS.
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Affiliation(s)
- Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Osman Özcebe
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Dıskapı Education and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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18
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Wiggers CRM, Govers AMAP, Lelieveld D, Egan DA, Zwaan CM, Sonneveld E, Coffer PJ, Bartels M. Epigenetic drug screen identifies the histone deacetylase inhibitor NSC3852 as a potential novel drug for the treatment of pediatric acute myeloid leukemia. Pediatr Blood Cancer 2019; 66:e27785. [PMID: 31044544 DOI: 10.1002/pbc.27785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a heterogeneous disease regarding morphology, immunophenotyping, genetic abnormalities, and clinical behavior. The overall survival rate of pediatric AML is 60% to 70%, and has not significantly improved over the past two decades. Children with Down syndrome (DS) are at risk of developing acute megakaryoblastic leukemia (AMKL), which can be preceded by a transient myeloproliferative disorder during the neonatal period. Intensification of current treatment protocols is not feasible due to already high treatment-related morbidity and mortality. Instead, more targeted therapies with less severe side effects are highly needed. PROCEDURE To identify potential novel therapeutic targets for myeloid disorders in children, including DS-AMKL and non-DS-AML, we performed an unbiased compound screen of 80 small molecules targeting epigenetic regulators in three pediatric AML cell lines that are representative for different subtypes of pediatric AML. Three candidate compounds were validated and further evaluated in normal myeloid precursor cells during neutrophil differentiation and in (pre-)leukemic pediatric patient cells. RESULTS Candidate drugs LMK235, NSC3852, and bromosporine were effective in all tested pediatric AML cell lines with antiproliferative, proapoptotic, and differentiation effects. Out of these three compounds, the pan-histone deacetylase inhibitor NSC3852 specifically induced growth arrest and apoptosis in pediatric AML cells, without disrupting normal neutrophil differentiation. CONCLUSION NSC3852 is a potential candidate drug for further preclinical testing in pediatric AML and DS-AMKL.
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Affiliation(s)
- Caroline R M Wiggers
- Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Hubrecht Institute, KNAW and University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anita M A P Govers
- Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Center for Molecular Medicine and Regenerative Medicine Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Daphne Lelieveld
- Cell Screening Core, Department of Cell Biology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David A Egan
- Cell Screening Core, Department of Cell Biology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Michel Zwaan
- Prinsess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Edwin Sonneveld
- Prinsess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group (DCOG), Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Paul J Coffer
- Center for Molecular Medicine and Regenerative Medicine Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marije Bartels
- Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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19
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Abdelhamed S, Butler JT, Doron B, Halse A, Nemecek E, Wilmarth PA, Marks DL, Chang BH, Horton T, Kurre P. Extracellular vesicles impose quiescence on residual hematopoietic stem cells in the leukemic niche. EMBO Rep 2019; 20:e47546. [PMID: 31267709 PMCID: PMC6607014 DOI: 10.15252/embr.201847546] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 01/19/2023] Open
Abstract
Progressive remodeling of the bone marrow microenvironment is recognized as an integral aspect of leukemogenesis. Expanding acute myeloid leukemia (AML) clones not only alter stroma composition, but also actively constrain hematopoiesis, representing a significant source of patient morbidity and mortality. Recent studies revealed the surprising resistance of long-term hematopoietic stem cells (LT-HSC) to elimination from the leukemic niche. Here, we examine the fate and function of residual LT-HSC in the BM of murine xenografts with emphasis on the role of AML-derived extracellular vesicles (EV). AML-EV rapidly enter HSC, and their trafficking elicits protein synthesis suppression and LT-HSC quiescence. Mechanistically, AML-EV transfer a panel of miRNA, including miR-1246, that target the mTOR subunit Raptor, causing ribosomal protein S6 hypo-phosphorylation, which in turn impairs protein synthesis in LT-HSC. While HSC functionally recover from quiescence upon transplantation to an AML-naive environment, they maintain relative gains in repopulation capacity. These phenotypic changes are accompanied by DNA double-strand breaks and evidence of a sustained DNA-damage response. In sum, AML-EV contribute to niche-dependent, reversible quiescence and elicit persisting DNA damage in LT-HSC.
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MESH Headings
- Animals
- Cell Line, Tumor
- Cells, Cultured
- DNA Breaks, Double-Stranded
- Extracellular Vesicles/metabolism
- Female
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Male
- Mice
- Mice, Inbred C57BL
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Regulatory-Associated Protein of mTOR/genetics
- Regulatory-Associated Protein of mTOR/metabolism
- Ribosomal Protein S6/genetics
- Stem Cell Niche
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Affiliation(s)
- Sherif Abdelhamed
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandORUSA
| | - John T Butler
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Department of Biomedical EngineeringOregon Health & Science UniversityPortlandORUSA
| | - Ben Doron
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
| | - Amber Halse
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
| | - Eneida Nemecek
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandORUSA
| | - Phillip A Wilmarth
- Department of Biochemistry and Molecular BiologyOregon Health & Science UniversityPortlandORUSA
- Proteomics Shared ResourcesOregon Health & Science UniversityPortlandORUSA
| | - Daniel L Marks
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandORUSA
- Brenden‐Colson Center for Pancreatic CareOregon Health & Science UniversityPortlandORUSA
| | - Bill H Chang
- Department of PediatricsPapé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandORUSA
| | - Terzah Horton
- Texas Children's Cancer and Hematology CentersBaylor College of MedicineHoustonTXUSA
| | - Peter Kurre
- Children's Hospital of PhiladelphiaComprehensive Bone Marrow Failure CenterPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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20
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Butler JT, Kurre P. Transmissible ER stress shapes the leukemic microenvironment. Oncotarget 2019; 10:4080-4082. [PMID: 31289607 PMCID: PMC6609251 DOI: 10.18632/oncotarget.27012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/26/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
- John T Butler
- Comprehensive Bone Marrow Failure Center, Children's Hospital of Philadelphia, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Kurre
- Comprehensive Bone Marrow Failure Center, Children's Hospital of Philadelphia, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Mustafa O, Abdalla K, AlAzmi AA, Elimam N, Abrar MB, Jastaniah W. FLAG/FLAG-IDA regimen for children with relapsed/refractory acute leukemia in the era of targeted novel therapies. J Oncol Pharm Pract 2018; 25:1831-1838. [PMID: 30518307 DOI: 10.1177/1078155218817816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outcomes of relapsed/refractory childhood acute leukemia remain poor. We analyzed the safety/efficacy of fludarabine, cytarabine, and granulocyte colony stimulating factor, with/without idarubicin (FLAG ± IDA) as salvage therapy compared with recent published results of novel therapies. METHODS This retrospective study included children aged 1 to 15 years with relapsed/refractory acute leukemia who received FLAG ± IDA salvage therapy from January 2000 to December 2014. Patients with infant leukemia, mixed lineage leukemia, Philadelphia-positive acute leukemia, or secondary leukemia were excluded. RESULT Fifty patients were identified: 25 with acute lymphoblastic leukemia and 25 with acute myeloid leukemia. The median age at initiation of FLAG ± IDA was seven years. Site of relapse was the bone marrow in 29, isolated central nervous system in 11, and combined in 10 patients. FLAG ± IDA was used after first relapse in 68% and after multiple relapses in 32%. Complete remission was achieved in 34 (68%) patients. No variables predictive of complete remission were identified. Grade 3 or greater toxicity was observed in 96% and 6% died from toxicity. Toxicities included hematologic toxicity (96%), infection (52%), and enterocolitis (28%). Twenty-four of 50 (48%) patients achieved a sustained complete remission and survived to bone marrow transplantation. The five-year overall survival was 23.9% ± 6.9%. Patients achieving second complete remission and patients proceeding to bone marrow transplantation following second complete remission demonstrated significantly improved overall survival (p = 0.001). CONCLUSION Despite a 68% complete remission rate using FLAG ± IDA, only 48% of patients survived to bone marrow transplantation. The regimen was associated with 96% toxicity and only one in four patients was alive at five years. This underscores the need to find more effective lower toxicity salvage regimens.
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Affiliation(s)
- Omima Mustafa
- Princess Noorah Oncology Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Khalid Abdalla
- Princess Noorah Oncology Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Aeshah A AlAzmi
- Department of Pharmaceutical Care, Clinical Pharmacy, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Naglla Elimam
- Princess Noorah Oncology Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mohammed Burhan Abrar
- Princess Noorah Oncology Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia
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22
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Niktoreh N, Lerius B, Zimmermann M, Gruhn B, Escherich G, Bourquin JP, Dworzak M, Sramkova L, Rossig C, Creutzig U, Reinhardt D, Rasche M. Gemtuzumab ozogamicin in children with relapsed or refractory acute myeloid leukemia: a report by Berlin-Frankfurt-Münster study group. Haematologica 2018; 104:120-127. [PMID: 30093401 PMCID: PMC6312035 DOI: 10.3324/haematol.2018.191841] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
Despite intensified salvage treatments, children with relapsed/refractory acute myeloid leukemia (AML) have poor survival. We evaluated gemtuzumab ozogamicin (CD33-targeted drug) used on a compassionate basis in patients diagnosed from 1995 until 2014 within Acute Myeloid Leukemia Berlin-Frankfurt-Münster studies, and identified 76 patients (<18 years) with highly-advanced and pre-treated AML [refractory de novo acute myeloid leukemia (n=10), de novo AML refractory to relapse (1st early: n=41; 1st late: n=10; 2nd or more: n=10), and secondary AML (n=5)]. At doses of 2.5–10 mg/m2, gemtuzumab ozogamicin was administered in 1-4 cycles as single agent (47%), combined with cytarabine (47%), or others (6%). Most common grade 3/4 adverse events were infections or febrile neutropenia (78% of severe adverse events), infusion-related immunological reactions (6%), and gastrointestinal symptoms (5%). Three patients experienced veno-occlusive disease (one fatal due to exacerbation of a pre-existing cardiomyopathy). Sixty-four percent received subsequent hematopoietic stem cell transplantation. Probability of 4-year overall survival was 18±5% in all, 27±7% in patients with and 0% in patients without hematopoietic stem cell transplantation (P<0.0001). Administration of gemtuzumab ozogamicin on a patient-specific, compassionate use basis was frequently considered in our study group and proved to be effective for bridging children with very advanced AML to hematopoietic stem cell transplantation. Uniform prospective studies for these patients are urgently needed.
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Affiliation(s)
- Naghmeh Niktoreh
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Beate Lerius
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, Eppendorf University Hospital, Hamburg, Germany
| | - Jean-Pierre Bourquin
- Division of Pediatric Hematology/Oncology, University Children's Hospital Zurich, Switzerland
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | - Lucie Sramkova
- Department of Pediatric Hematology and Oncology, 2 Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Claudia Rossig
- University Children's Hospital Münster, Pediatric Hematology and Oncology, Germany
| | - Ursula Creutzig
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Mareike Rasche
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
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23
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van Eijkelenburg NKA, Rasche M, Ghazaly E, Dworzak MN, Klingebiel T, Rossig C, Leverger G, Stary J, De Bont ESJM, Chitu DA, Bertrand Y, Brethon B, Strahm B, van der Sluis IM, Kaspers GJL, Reinhardt D, Zwaan CM. Clofarabine, high-dose cytarabine and liposomal daunorubicin in pediatric relapsed/refractory acute myeloid leukemia: a phase IB study. Haematologica 2018; 103:1484-1492. [PMID: 29773602 PMCID: PMC6119144 DOI: 10.3324/haematol.2017.187153] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 05/16/2018] [Indexed: 12/29/2022] Open
Abstract
Survival in children with relapsed/refractory acute myeloid leukemia is unsatisfactory. Treatment consists of one course of fludarabine, cytarabine and liposomal daunorubicin, followed by fludarabine and cytarabine and stem-cell transplantation. Study ITCC 020/I-BFM 2009-02 aimed to identify the recommended phase II dose of clofarabine replacing fludarabine in the abovementioned combination regimen (3+3 design). Escalating dose levels of clofarabine (20-40 mg/m2/day × 5 days) and liposomal daunorubicin (40-80 mg/m2/day) were administered with cytarabine (2 g/m2/day × 5 days). Liposomal DNR was given on day 1, 3 and 5 only. The cohort at the recommended phase II dose was expanded to make a preliminary assessment of anti-leukemic activity. Thirty-four children were enrolled: refractory 1st (n=11), early 1st (n=15), ≥2nd relapse (n=8). Dose level 3 (30 mg/m2clofarabine; 60 mg/m2liposomal daunorubicin) appeared to be safe only in patients without subclinical fungal infections. Infectious complications were dose-limiting. The recommended phase II dose was 40 mg/m2 clofarabine with 60 mg/m2 liposomal daunorubicin. Side-effects mainly consisted of infections. The overall response rate was 68% in 31 response evaluable patients, and 80% at the recommended phase II dose (n=10); 22 patients proceeded to stem cell transplantation. The 2-year probability of event-free survival (pEFS) was 26.5±7.6 and probability of survival (pOS) 32.4±8.0%. In the 21 responding patients, the 2-year pEFS was 42.9±10.8 and pOS 47.6±10.9%. Clofarabine exposure in plasma was not significantly different from that in single-agent studies. In conclusion, clofarabine was well tolerated and showed high response rates in relapsed/refractory pediatric acute myeloid leukemia. Patients with (sub) clinical fungal infections should be treated with caution. Clofarabine has been taken forward in the Berlin-Frankfurt-Münster study for newly diagnosed acute myeloid leukemia. The Study ITCC-020 was registered as EUDRA-CT 2009-009457-13; Dutch Trial Registry number 1880.
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Affiliation(s)
- Natasha K A van Eijkelenburg
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,European Consortium for Innovative Therapies for Children with Cancer (ITCC), Villejuif, France
| | - Mareike Rasche
- Department of Pediatric Oncology, University Children's Hospital, Essen, Germany
| | - Essam Ghazaly
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, UK
| | - Michael N Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Austria
| | - Thomas Klingebiel
- Pediatric Hematology/Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Claudia Rossig
- Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, AP-HP, GH HUEP, Trousseau Hospital, Paris, France
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, 2Faculty of Medicine, Charles University Prague, University Hospital Motol, Czech Republic
| | - Eveline S J M De Bont
- Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Dana A Chitu
- Clinical Trial Center, Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yves Bertrand
- Pediatric Hematology Department, IHOP and Claude Bernard University, Lyon, France
| | - Benoit Brethon
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - Brigitte Strahm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Germany
| | - Inge M van der Sluis
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,European Consortium for Innovative Therapies for Children with Cancer (ITCC), Villejuif, France
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, VU University Medical Center, Amsterdam, the Netherlands.,I-BFM-AML committee, Kiel, Germany
| | - Dirk Reinhardt
- European Consortium for Innovative Therapies for Children with Cancer (ITCC), Villejuif, France.,I-BFM-AML committee, Kiel, Germany
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands .,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,European Consortium for Innovative Therapies for Children with Cancer (ITCC), Villejuif, France
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24
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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25
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Aziz H, Ping CY, Alias H, Ab Mutalib NS, Jamal R. Gene Mutations as Emerging Biomarkers and Therapeutic Targets for Relapsed Acute Myeloid Leukemia. Front Pharmacol 2017; 8:897. [PMID: 29270125 PMCID: PMC5725465 DOI: 10.3389/fphar.2017.00897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/24/2017] [Indexed: 12/19/2022] Open
Abstract
It is believed that there are key differences in the genomic profile between adult and childhood acute myeloid leukemia (AML). Relapse is the significant contributor of mortality in patients with AML and remains as the leading cause of cancer death among children, posing great challenges in the treatment of AML. The knowledge about the genomic lesions in childhood AML is still premature as most genomic events defined in children were derived from adult cohorts. However, the emerging technologies of next generation sequencing have narrowed the gap of knowledge in the biology of AML by the detection of gene mutations for each sub-type which have led to the improvement in terms of prognostication as well as the use of targeted therapies. In this review, we describe the recent understanding of the genomic landscape including the prevalence of mutation, prognostic impact, and targeted therapies that will provide an insight into the pathogenesis of AML relapse in both adult and childhood cases.
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Affiliation(s)
- Habsah Aziz
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chow Y Ping
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Rahman Jamal
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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26
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Nakayama H, Tomizawa D, Tanaka S, Iwamoto S, Shimada A, Saito AM, Yamashita Y, Moritake H, Terui K, Taga T, Matsuo H, Kosaka Y, Koh K, Hosoi H, Kurosawa H, Isoyama K, Horibe K, Mizutani S, Adachi S. Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia. Pediatr Int 2017; 59:1046-1052. [PMID: 28771903 DOI: 10.1111/ped.13378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/21/2017] [Accepted: 07/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The combination of fludarabine (Flu), high-dose cytarabine (Ara-C) and granulocyte colony-stimulating factor (G-CSF; FLAG), with anthracyclines has become standard chemotherapy for refractory acute myeloid leukemia (AML) in European children and adults. To clarify the efficacy and the safety of FLAG-idarubicin (IDA) for children prospectively, we planned a multicenter phase II study (AML-R11) by the Japanese Pediatric Leukemia/Lymphoma Study Group. METHODS Patients with AML aged between 2 and 20 years old, who had the first bone marrow (BM) relapse or induction failure, were enrolled. The FLAG-IDA regimen consisted of Flu 30 mg/m2 for 5 days, Ara-C 2 g/m2 for 5 days, G-CSF (lenograstim) 5 μg/kg for 6 days and IDA 10 mg/m2 for 3 days. The primary endpoint was remission rate after therapy. RESULTS Due to drug supply issues, the trial was suspended after the inclusion of seven eligible patients. There were six cases of early relapse within 1 year of the first remission. All seven patients completed the therapy and no early death was observed. Hematological toxicity was common, and one patient developed grade 4 non-hematological toxicity of bacterial meningitis. Although only one patient with late relapse achieved complete remission, minimal residual disease was positive on both flow cytometry and Wilms' tumor 1 mRNA. Two patients were alive in remission following hematopoietic stem cell transplantation, whereas the other five patients died of either the disease or treatment-related causes. CONCLUSION FLAG-IDA might be tolerable for children with refractory AML although the efficacy should be further investigated.
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Affiliation(s)
- Hideki Nakayama
- Department of Pediatrics, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.,Department of Pediatrics, National Hospital Organization Fukuoka-Higashi Medical Center, Fukuoka, Japan.,Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shotaro Iwamoto
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akira Shimada
- Department of Pediatrics, Okayama University, Okayama, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuka Yamashita
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroshi Moritake
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kiminori Terui
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Ohtsu, Japan
| | - Hidemasa Matsuo
- School of Human Health Science, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Kosaka
- Department of Pediatric Hematology/Oncology, Hyougo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Keiichi Isoyama
- Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shuki Mizutani
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Souichi Adachi
- School of Human Health Science, Faculty of Medicine, Kyoto University, Kyoto, Japan
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27
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Buldini B, Rizzati F, Masetti R, Fagioli F, Menna G, Micalizzi C, Putti MC, Rizzari C, Santoro N, Zecca M, Disarò S, Rondelli R, Merli P, Pigazzi M, Pession A, Locatelli F, Basso G. Prognostic significance of flow-cytometry evaluation of minimal residual disease in children with acute myeloid leukaemia treated according to the AIEOP-AML 2002/01 study protocol. Br J Haematol 2017; 177:116-126. [PMID: 28240765 DOI: 10.1111/bjh.14523] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In children with acute myeloid leukaemia (AML), assessment of initial treatment response is an essential prognostic factor; methods more sensitive than morphology are still under evaluation. We report on the measurement of minimal residual disease (MRD), by multicolour flow-cytometry in one centralized laboratory, in 142 children with newly diagnosed AML enrolled in the Associazione Italiana di EmatoOncologia Pediatrica-AML 2002/01 trial. At the end of the first induction course, MRD was <0·1% in 69, 0·1-1% in 16 and >1% in 51 patients. The 8-year disease-free survival (DFS) of 125 children in morphological complete remission and with MRD <0·1%, 0·1-1% and ≥1% was 73·1 ± 5·6%, 37·8 ± 12·1% and 34·1 ± 8·8%, respectively (P < 0·01). MRD was also available after the second induction course in 92/142 patients. MRD was ≥0·1% at the end of the first induction course in 36 patients; 13 reached an MRD <0·1% after the second one and their DFS was 45·4 ± 16·7% vs. 22·8 ± 8·9% in patients with persisting MRD ≥0·1% (P = 0·037). Multivariate analysis demonstrated that MRD ≥0·1% after first induction course was, together with a monosomal karyotype, an independent adverse prognostic factor for DFS. Our results show that MRD detected by flow-cytometry after induction therapy predicts outcome in patients with childhood AML and can help stratifying post-remission treatment.
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Affiliation(s)
- Barbara Buldini
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Frida Rizzati
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Riccardo Masetti
- Department of Pediatrics, Lalla Seragnoli, Haematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Franca Fagioli
- Pediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Giuseppe Menna
- Department of Pediatric Haemato-Oncology, Santobono-Pausilipon Hospital, Napoli, Italy
| | - Concetta Micalizzi
- Department of Pediatric Haemato-Oncology, IRCCS Istituto "Giannina Gaslini", Genova, Italy
| | - Maria Caterina Putti
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Carmelo Rizzari
- Department of Pediatrics, Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy
| | - Nicola Santoro
- Department of Pediatrics, Policlinico di Bari, Bari, Italy
| | - Marco Zecca
- Department of Pediatric Haemato-Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Silvia Disarò
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Roberto Rondelli
- Department of Pediatrics, Lalla Seragnoli, Haematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Pietro Merli
- Department of Pediatric Haematology-Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Bambino Gesù, Rome; University of Pavia, Pavia, Italy
| | - Martina Pigazzi
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Andrea Pession
- Department of Pediatrics, Lalla Seragnoli, Haematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Franco Locatelli
- Department of Pediatric Haematology-Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Bambino Gesù, Rome; University of Pavia, Pavia, Italy
| | - Giuseppe Basso
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
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28
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O'Hare P, Lucchini G, Cummins M, Veys P, Potter M, Lawson S, Vora A, Wynn R, Peniket A, Kirkland K, Pearce R, Perry J, Amrolia PJ. Allogeneic stem cell transplantation for refractory acute myeloid leukemia in pediatric patients: the UK experience. Bone Marrow Transplant 2017; 52:825-831. [DOI: 10.1038/bmt.2017.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/28/2022]
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29
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Worst BC, van Tilburg CM, Balasubramanian GP, Fiesel P, Witt R, Freitag A, Boudalil M, Previti C, Wolf S, Schmidt S, Chotewutmontri S, Bewerunge-Hudler M, Schick M, Schlesner M, Hutter B, Taylor L, Borst T, Sutter C, Bartram CR, Milde T, Pfaff E, Kulozik AE, von Stackelberg A, Meisel R, Borkhardt A, Reinhardt D, Klusmann JH, Fleischhack G, Tippelt S, Dirksen U, Jürgens H, Kramm CM, von Bueren AO, Westermann F, Fischer M, Burkhardt B, Wößmann W, Nathrath M, Bielack SS, Frühwald MC, Fulda S, Klingebiel T, Koscielniak E, Schwab M, Tremmel R, Driever PH, Schulte JH, Brors B, von Deimling A, Lichter P, Eggert A, Capper D, Pfister SM, Jones DTW, Witt O. Next-generation personalised medicine for high-risk paediatric cancer patients - The INFORM pilot study. Eur J Cancer 2016; 65:91-101. [PMID: 27479119 DOI: 10.1016/j.ejca.2016.06.009] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
The 'Individualized Therapy for Relapsed Malignancies in Childhood' (INFORM) precision medicine study is a nationwide German program for children with high-risk relapsed/refractory malignancies, which aims to identify therapeutic targets on an individualised basis. In a pilot phase, reported here, we developed the logistical and analytical pipelines necessary for rapid and comprehensive molecular profiling in a clinical setting. Fifty-seven patients from 20 centers were prospectively recruited. Malignancies investigated included sarcomas (n = 25), brain tumours (n = 23), and others (n = 9). Whole-exome, low-coverage whole-genome, and RNA sequencing were complemented with methylation and expression microarray analyses. Alterations were assessed for potential targetability according to a customised prioritisation algorithm and subsequently discussed in an interdisciplinary molecular tumour board. Next-generation sequencing data were generated for 52 patients, with the full analysis possible in 46 of 52. Turnaround time from sample receipt until first report averaged 28 d. Twenty-six patients (50%) harbored a potentially druggable alteration with a prioritisation score of 'intermediate' or higher (level 4 of 7). Common targets included receptor tyrosine kinases, phosphoinositide 3-kinase-mammalian target of rapamycin pathway, mitogen-activated protein kinase pathway, and cell cycle control. Ten patients received a targeted therapy based on these findings, with responses observed in some previously treatment-refractory tumours. Comparative primary relapse analysis revealed substantial tumour evolution as well as one case of unsuspected secondary malignancy, highlighting the importance of re-biopsy at relapse. This study demonstrates the feasibility of comprehensive, real-time molecular profiling for high-risk paediatric cancer patients. This extended proof-of-concept, with examples of treatment consequences, expands upon previous personalised oncology endeavors, and presents a model with considerable interest and practical relevance in the burgeoning era of personalised medicine.
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Affiliation(s)
- Barbara C Worst
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Cornelis M van Tilburg
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Gnana Prakash Balasubramanian
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Petra Fiesel
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Ruth Witt
- NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany.
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany.
| | - Miream Boudalil
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Christopher Previti
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Stephan Wolf
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Sabine Schmidt
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Sasithorn Chotewutmontri
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Schick
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Schlesner
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Barbara Hutter
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Lenka Taylor
- Pharmacy Department, Heidelberg University Hospital, Im Neuenheimer Feld 670, Heidelberg, 69120, Germany.
| | - Tobias Borst
- Pharmacy Department, Erlangen University Hospital, Palmsanlage 3, Erlangen, 91054, Germany.
| | - Christian Sutter
- Institute of Human Genetics, Heidelberg University Hospital, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany.
| | - Claus R Bartram
- Institute of Human Genetics, Heidelberg University Hospital, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany.
| | - Till Milde
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Elke Pfaff
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany.
| | - Arend von Stackelberg
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Düsseldorf University Hospital, Medical Faculty, Moorenstr. 5, Düsseldorf, 40225, Germany.
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Düsseldorf University Hospital, Medical Faculty, Moorenstr. 5, Düsseldorf, 40225, Germany.
| | - Dirk Reinhardt
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Jan-Henning Klusmann
- Department of Pediatric Hematology & Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
| | - Gudrun Fleischhack
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Stephan Tippelt
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Uta Dirksen
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Heribert Jürgens
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Christof M Kramm
- Division of Pediatric Hematology & Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
| | - Andre O von Bueren
- Division of Pediatric Hematology & Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, 37075, Germany; Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland.
| | - Frank Westermann
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Fischer
- Department of Pediatric Hematology & Oncology, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50937, Germany; Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Str. 21, Cologne, 50931, Germany; Max Planck Institute for Metabolism Research, Gleueler Str. 50, Cologne, 50931, Germany.
| | - Birgit Burkhardt
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Wilhelm Wößmann
- Department of Pediatric Hematology and Oncology, University Hospital of Gießen, Feulgenstr. 12, Gießen, 35392, Germany.
| | - Michaela Nathrath
- Department of Pediatric Oncology, Klinikum Kassel, Mönchebergstr. 41-43, Kassel, 34125, Germany; Pediatric Oncology Center, Technische Universität München, Kölner Platz 1, Munich, 80804, Germany.
| | - Stefan S Bielack
- Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart Olgahospital, Kriegsbergstr. 62, Stuttgart, 70174, Germany.
| | - Michael C Frühwald
- Swabian Children's Cancer Center, Children's Hospital, Klinikum Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany.
| | - Simone Fulda
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Institute for Experimental Cancer Research in Pediatrics, University Hospital Frankfurt, Komturstr. 3a, Frankfurt am Main, 60528, Germany.
| | - Thomas Klingebiel
- Department of Pediatric Oncology & Hematology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Ewa Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart Olgahospital, Kriegsbergstr. 62, Stuttgart, 70174, Germany.
| | - Matthias Schwab
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstr. 112, Stuttgart, 70376, Germany; Departments of Clinical Pharmacology and Pharmacy and Biochemistry, University of Tübingen, Auf der Morgenstelle 8, Tübingen, 72076, Germany.
| | - Roman Tremmel
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstr. 112, Stuttgart, 70376, Germany; Departments of Clinical Pharmacology and Pharmacy and Biochemistry, University of Tübingen, Auf der Morgenstelle 8, Tübingen, 72076, Germany.
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Johannes H Schulte
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany; Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Benedikt Brors
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Andreas von Deimling
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Peter Lichter
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Angelika Eggert
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - David Capper
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Olaf Witt
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
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30
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Yamazaki E, Kanamori H, Itabashi M, Ogusa E, Numata A, Yamamoto W, Ito S, Tachibana T, Hagihara M, Matsumoto K, Koharazawa H, Taguchi J, Tomita N, Fujimaki K, Fujita H, Fujisawa S, Ogawa K, Ishigatsubo Y. Hyper-recovery of platelets after induction therapy is a predictor of relapse-free survival in acute myeloid leukemia. Leuk Lymphoma 2016; 58:104-109. [PMID: 27267543 DOI: 10.1080/10428194.2016.1190969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We verified the association between standard clinical and laboratory variables and the risk of relapse in acute myeloid leukemia (AML), which led us to retrospectively examine the effect of regeneration of hematopoiesis in patients with newly diagnosed AML. We used data from 230 patients who obtained remission after cytarabine-based induction chemotherapy. Platelet counts ≥500 × 109/L and hemoglobin levels ≥9 g/dL on day 28 after treatment initiation were significantly associated with relapse-free survival (RFS) rate, conferring respective multivariate risk ratios of 0.38 (95% CI: 0.18-0.79) and 0.60 (95% CI: 0.40-0.89) for the occurrence of relapse or death. No disease relapse occurred in core binding factor leukemia patients whose platelet counts recovered ≥500 × 109/L at 28 days after therapy initiation. We conclude that regeneration of hematopoiesis, especially platelet hyper-recovery, after induction chemotherapy is a significant predictor of RFS in patients with AML.
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Affiliation(s)
- Etsuko Yamazaki
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Heiwa Kanamori
- b Department of Hematology , Kanagawa Cancer Center , Yokohama , Japan
| | - Megumi Itabashi
- c Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Eriko Ogusa
- b Department of Hematology , Kanagawa Cancer Center , Yokohama , Japan
| | - Ayumi Numata
- c Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Wataru Yamamoto
- b Department of Hematology , Kanagawa Cancer Center , Yokohama , Japan
| | - Satomi Ito
- d Department of Hematology , Shizuoka Red Cross Hospital , Shizuoka , Japan
| | - Takayoshi Tachibana
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Maki Hagihara
- c Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Kenji Matsumoto
- b Department of Hematology , Kanagawa Cancer Center , Yokohama , Japan
| | - Hideyuki Koharazawa
- e Department of Hematology/Oncology , Yamato Municipal Hospital , Yamato , Japan
| | - Jun Taguchi
- d Department of Hematology , Shizuoka Red Cross Hospital , Shizuoka , Japan
| | - Naoto Tomita
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Katsumichi Fujimaki
- f Department of Hematology/Immunology , Fujisawa City Hospital , Fujisawa , Japan
| | - Hiroyuki Fujita
- g Department of Hematology , Saiseikai Yokohama Nanbu Hospital , Yokohama , Japan
| | - Shin Fujisawa
- c Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Koji Ogawa
- h Department of Hematology , Yokosuka City Hospital , Yokosuka , Japan
| | - Yoshiaki Ishigatsubo
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Japan
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31
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Hope and hype surrounding circulating microRNA as potential next generation AML biomarkers. Leuk Res 2015; 39:1309-11. [DOI: 10.1016/j.leukres.2015.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 01/24/2023]
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32
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Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, De Bont ESJM, De Moerloose B, Dworzak M, Gibson BES, Hasle H, Leverger G, Locatelli F, Ragu C, Ribeiro RC, Rizzari C, Rubnitz JE, Smith OP, Sung L, Tomizawa D, van den Heuvel-Eibrink MM, Creutzig U, Kaspers GJL. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2949-62. [PMID: 26304895 DOI: 10.1200/jco.2015.62.8289] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects.
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Affiliation(s)
- C Michel Zwaan
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Edward A Kolb
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Dirk Reinhardt
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jonas Abrahamsson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Souichi Adachi
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Richard Aplenc
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Eveline S J M De Bont
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Barbara De Moerloose
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Michael Dworzak
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Brenda E S Gibson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Henrik Hasle
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Guy Leverger
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Franco Locatelli
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Christine Ragu
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Raul C Ribeiro
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Carmelo Rizzari
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jeffrey E Rubnitz
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Owen P Smith
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Lillian Sung
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Daisuke Tomizawa
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Marry M van den Heuvel-Eibrink
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Ursula Creutzig
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Gertjan J L Kaspers
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
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Gustafsson BM. Different aspects of stem cell procedures in children with poor responding AML: when is HSCT the best answer? Int J Hematol Oncol 2015. [DOI: 10.2217/ijh.15.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute myeloid leukemia in children is a heterogeneous disease with different morphological and cytogenetic features. New diagnostic tools and treatments, improved supportive care and the use of genomic tissue typing in selecting donors for hematopoietic stem cell transplantation (HSCT) adds to increased survival rates. Candidates to HSCT in first complete remission are patients with cytogenetic or molecular unfavorable prognostic markers, or blasts >15% after first induction. The use of minimal residual disease can also identify children benefiting from HSCT in first complete remission and the patients post HSCT with signs of relapse. The outcome and cure rate of acute myeloid leukemia, still remains poor and new diagnostic tools and treatments strategies need to be evaluated. In this management perspective, future management of novel minimal residual disease tools are discussed, conditioning therapies, as well as different transplantation procedures including haplo-transplantation and haplo-identical natural killer cell transplantation, but also altered graft-versus-host-disease treatments.
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Affiliation(s)
- Britt M Gustafsson
- Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, SE141 86 Stockholm, Sweden
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Abstract
Pediatric acute myeloid leukemia (AML) represents 15%-20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%-10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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de Rooij JDE, Zwaan CM, van den Heuvel-Eibrink M. Pediatric AML: From Biology to Clinical Management. J Clin Med 2015; 4:127-49. [PMID: 26237023 PMCID: PMC4470244 DOI: 10.3390/jcm4010127] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022] Open
Abstract
Pediatric acute myeloid leukemia (AML) represents 15%–20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%–10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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Affiliation(s)
- Jasmijn D E de Rooij
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
| | - C Michel Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
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36
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Kaspers G. How I treat paediatric relapsed acute myeloid leukaemia. Br J Haematol 2014; 166:636-45. [PMID: 24837715 DOI: 10.1111/bjh.12947] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/10/2014] [Indexed: 11/28/2022]
Abstract
The prognosis of paediatric acute myeloid leukaemia (AML) has improved significantly over the recent decades, but still about one-third of patients relapse. These patients have a relatively poor prognosis, with a probability of long-term survival from relapse of about 35%. This can only be achieved with very intensive chemotherapy and, usually, allogeneic stem cell transplantation, leading to very significant toxicity and even treatment-related mortality. Major improvements in the treatment of paediatric relapsed AML thus are required still, and several possibilities are discussed. In case of a suspected relapse, a comprehensive diagnostic work-up has to be undertaken, because significant changes in the biological features of the AML cells may have occurred between initial diagnosis and relapse. This review discusses many practical issues that one encounters in the treatment of children with relapsed AML. It will also be of interest for those involved in translational research in AML.
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Affiliation(s)
- Gertjan Kaspers
- Paediatric Oncology/Haematology, VU University Medical Center, Amsterdam, The Netherlands
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