A review on allogeneic stem cell transplantation for newly diagnosed pediatric acute myeloid leukemia

• Published in: Blood Vol. 116; no. 13; pp. 2205 - 2214
• Main Authors: Niewerth, Denise, Creutzig, Ursula, Bierings, Marc B., Kaspers, Gertjan J.L.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 30.09.2010; Americain Society of Hematology
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Child; Clinical Trials, Phase III as Topic; Cost-Benefit Analysis; Disease-Free Survival; Hematologic and hematopoietic diseases; Humans; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Remission Induction; Stem Cell Transplantation - adverse effects; Stem Cell Transplantation - economics; Survival Analysis; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Human; Pediatrics; Acute myelogenous leukemia; Hematology; Stem cell; Hematopoietic cell; Homograft; Early stage; Malignant hemopathy; Review; Graft; Child; Bibliographic review; Cancer
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2010-01-261800

Survival of pediatric acute myeloid leukemia (AML) has improved considerably over the past decades. Since 1985, allogeneic stem cell transplantation (allo-SCT) is widely recommended for patients who have a matched sibling donor. However, it remains controversial whether allo-SCT is superior to chemotherapy for children with newly diagnosed AML. This review summarizes phase 3 clinical trials that compared allo-SCT with chemotherapy (including autologous SCT) in pediatric AML, excluding studies that did not use the intention-to-treat analysis or correct for time-to-transplantation. Although allo-SCT might prevent more relapses than chemotherapy, the number needed for transplantation (with allo-SCT) to prevent one relapse is in the order of 10 patients. Moreover, overall survival is similar with both methods in most recent studies, apparently because of increased salvagability of a relapse when initial therapy concerned chemotherapy only, and because of a higher treatment-related mortality with allo-SCT. Because allo-SCT also gives more severe side effects and results more often in secondary malignancies than chemotherapy, we do not recommend allo-SCT in first remission for pediatric AML in general. Further research should focus on the possibility that subgroups might benefit from allo-SCT, aiming at further improvements in the prognosis of pediatric AML.