Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival
International Working Group (IWG) and European LeukemiaNet (ELN) response definitions are utilized to evaluate the efficacy of new agents for childhood acute myeloid leukemia (AML) for regulatory purposes. However, these criteria are not consistent with definitions used in pediatric AML trials or wi...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-01-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/3/616 |
| _version_ | 1797488755239550976 |
|---|---|
| author | Lauren Pommert Todd M. Cooper Robert B. Gerbing Lisa Brodersen Michael Loken Alan Gamis Richard Aplenc Todd A. Alonzo Edward Anders Kolb |
| author_facet | Lauren Pommert Todd M. Cooper Robert B. Gerbing Lisa Brodersen Michael Loken Alan Gamis Richard Aplenc Todd A. Alonzo Edward Anders Kolb |
| author_sort | Lauren Pommert |
| collection | DOAJ |
| description | International Working Group (IWG) and European LeukemiaNet (ELN) response definitions are utilized to evaluate the efficacy of new agents for childhood acute myeloid leukemia (AML) for regulatory purposes. However, these criteria are not consistent with definitions used in pediatric AML trials or with standard pediatric practice to proceed with subsequent therapy cycles prior to IWG/ELN-defined count recovery. We retrospectively analyzed data from the two most recent Phase 3 pediatric AML clinical trials conducted by the Children’s Oncology Group (COG) to assess the incidence, timing, and prognostic significance of count recovery following induction chemotherapy. Of the patients with fewer than 5% bone marrow blasts at the end of first induction, 21.5% of patients proceeded to a second induction cycle prior to achieving ANC ≥ 500 cells/μL and platelets ≥ 50,000 cells/μL, both well below the IWG/ELN thresholds of ANC > 1000 cells/μL and platelets > 100,000 cells/μL. In these two sequential childhood AML Phase 3 trials, neither ANC nor platelet recovery predicted survival. Intensification of treatment through the initiation of subsequent therapy cycles prior to attainment of IWG/ELN-defined CR is common practice in clinical trials for children with AML, suggesting that updated response definitions are needed for pediatric AML. |
| first_indexed | 2024-03-10T00:06:50Z |
| format | Article |
| id | doaj.art-032973ec4ad84ba6ae987b1c6e7ffa7c |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:06:50Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-032973ec4ad84ba6ae987b1c6e7ffa7c2023-11-23T16:05:49ZengMDPI AGCancers2072-66942022-01-0114361610.3390/cancers14030616Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict SurvivalLauren Pommert0Todd M. Cooper1Robert B. Gerbing2Lisa Brodersen3Michael Loken4Alan Gamis5Richard Aplenc6Todd A. Alonzo7Edward Anders Kolb8Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USADivision of Hematology/Oncology, Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA 98105, USAChildren’s Oncology Group, Monrovia, CA 91016, USAHematologics Inc., Seattle, WA 98121, USAHematologics Inc., Seattle, WA 98121, USAChildren’s Mercy Hospital and Clinics, Kansas City, MO 64108, USADivision of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USADepartment of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90032, USANemours Center for Cancer and Blood Disorders/Nemours Children’s Health, Wilmington, DE 19803, USAInternational Working Group (IWG) and European LeukemiaNet (ELN) response definitions are utilized to evaluate the efficacy of new agents for childhood acute myeloid leukemia (AML) for regulatory purposes. However, these criteria are not consistent with definitions used in pediatric AML trials or with standard pediatric practice to proceed with subsequent therapy cycles prior to IWG/ELN-defined count recovery. We retrospectively analyzed data from the two most recent Phase 3 pediatric AML clinical trials conducted by the Children’s Oncology Group (COG) to assess the incidence, timing, and prognostic significance of count recovery following induction chemotherapy. Of the patients with fewer than 5% bone marrow blasts at the end of first induction, 21.5% of patients proceeded to a second induction cycle prior to achieving ANC ≥ 500 cells/μL and platelets ≥ 50,000 cells/μL, both well below the IWG/ELN thresholds of ANC > 1000 cells/μL and platelets > 100,000 cells/μL. In these two sequential childhood AML Phase 3 trials, neither ANC nor platelet recovery predicted survival. Intensification of treatment through the initiation of subsequent therapy cycles prior to attainment of IWG/ELN-defined CR is common practice in clinical trials for children with AML, suggesting that updated response definitions are needed for pediatric AML.https://www.mdpi.com/2072-6694/14/3/616pediatric acute myeloid leukemiachildhood acute myeloid leukemiaclinical trial response assessmentIWG criteria |
| spellingShingle | Lauren Pommert Todd M. Cooper Robert B. Gerbing Lisa Brodersen Michael Loken Alan Gamis Richard Aplenc Todd A. Alonzo Edward Anders Kolb Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival Cancers pediatric acute myeloid leukemia childhood acute myeloid leukemia clinical trial response assessment IWG criteria |
| title | Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival |
| title_full | Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival |
| title_fullStr | Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival |
| title_full_unstemmed | Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival |
| title_short | Blood Count Recovery Following Induction Therapy for Acute Myeloid Leukemia in Children Does Not Predict Survival |
| title_sort | blood count recovery following induction therapy for acute myeloid leukemia in children does not predict survival |
| topic | pediatric acute myeloid leukemia childhood acute myeloid leukemia clinical trial response assessment IWG criteria |
| url | https://www.mdpi.com/2072-6694/14/3/616 |
| work_keys_str_mv | AT laurenpommert bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT toddmcooper bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT robertbgerbing bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT lisabrodersen bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT michaelloken bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT alangamis bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT richardaplenc bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT toddaalonzo bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival AT edwardanderskolb bloodcountrecoveryfollowinginductiontherapyforacutemyeloidleukemiainchildrendoesnotpredictsurvival |