All issues > Volume 31(7); 1988

Original Article

J Korean Pediatr Soc. 1988;31(7):850-862. Published online July 31, 1988.

Treatment of Acute Myelogenous Leukemia in Children: Remission Induction with Adriamycin and Cytosine Arabinoside, and Postremission Maintenance Chemotherapy with Adriamycin, Cytosine Arabinoside and 6-thioguanine.

Soon Ki Kim¹, Hyo Seop Ahn¹, Chang Yee Hong¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea

Received: June 9, 1988;  Accepted: June 9, 1988.

Abstract

The authers assessed the effectiveness of chemotherapy in 40 children with AML, experienced at Seoul National University Children’s Hospital during 8 years 5 months from April 1979 to August 1987. Remission induction treatment included adriamycin 30 mg/m2/day IV on days 1-3 and cytosine arabinoside 75 mg/m2/day continuous IV infusion on days 1-5. This regimen was repeated, if necessary, for one or two more courses. After complete remission central nervous system prophylaxis was performed with cranial irradiation (1800 rad) and intrathecal methotrexate (6 times). Those who achieved complete remission received monthly maintenance therapy with adriamycin on day 1, cytosine arabinoside days 1-5 and 6-thioguanine 50 mg/m2/day PO days 1-5 for 3 years. But adriamycin was stopped on the total cumulative dose of 550 mg/m2. The results of treatment were as follows; 1) The rate of complete remission was 72.5% (25/40), which was achieved on median 43rd day. 2) Causes of induction failure were drug resistance in 8 cases (20%) and 7 (17.5%) of death during induction which included infection in 3 cases, bleeding in 3, and infection and bleeding in 1. 3) Median remission duration was 14 months. The life table analysis revealed a probability for overall survival after 2 years 49% (S.E. 30%) and for relapse-free survival 35% (S.E. 24%). 4) Among 17 patients who achieved complete remission, relapse was observed in 9 cases which included 7 of bone marrow relapse and 2 of CNS relapse who had not received CNS prophylaxis. 5) An initial high level of serum lactic dehydrogenase was unfavorable parameter for achieving remission. 6) Side effects during induction chemotherapy included alopecia in 34 patients (100%), nausea/ vomiting in 33 (97%), stomatitis in 33 (97%), abdominal pain in 9 (26%) and hepatotoxity in 3 (9%). The applied treatment strategy is successful in inducing complete remission in about two thirds of children with AML. But recently more improved results have been reported. This suggests that more aggressive or intensified regimen may be required with the better suppor- tive care and that the application of CNS prophylaxis in childhood AML is recommended.

Keywords :Acute myelogenous leukemia, Chemotherapy, Central nervous system prophylaxis