Strategies for reducing the treatment‐related physical burden of childhood acute myeloid leukaemia – a review

Summary Over the last four decades the survival of paediatric patients with acute myeloid leukaemia has gradually increased to 70% in high‐income countries. The therapy is very intensive and associated with many acute and long‐term side effects. The early death rate has been reduced to 1–4%. The acu...

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Bibliographic Details
Published in:British journal of haematology 2017-01, Vol.176 (2), p.168-178
Main Authors: Hasle, Henrik, Kaspers, Gertjan J. L.
Format: Article
Language:English
Subjects:
acute myeloid leukaemia
Acute myeloid leukemia
Acute toxicity
Anthracycline
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Cardiotoxicity
Cardiotoxicity - etiology
Child
childhood leukaemia
Children
Consolidation
Hematology
Humans
late effects
Leukemia
Leukemia, Myeloid, Acute - complications
Leukemia, Myeloid, Acute - mortality
Leukemia, Myeloid, Acute - therapy
Remission
Secondary Prevention
Side effects
Stem cell transplantation
Stem Cell Transplantation - methods
Survival
Toxicity
Transplantation
Transplants & implants
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Summary:Summary Over the last four decades the survival of paediatric patients with acute myeloid leukaemia has gradually increased to 70% in high‐income countries. The therapy is very intensive and associated with many acute and long‐term side effects. The early death rate has been reduced to 1–4%. The acute toxicity is a limiting factor for improving survival in low‐income countries. Transplant is associated with more endocrinological late effects while cardiotoxicity is more common after relapse. Reducing the physical costs of therapy without jeopardizing survival may be accomplished by optimal supportive care, less cardiotoxic anthracyclines, less consolidation courses and strict indications for stem cell transplantation. Analysing scenarios with different frequency of transplantation in first complete remission show similar overall survival rates, indicating that almost all patients can be spared the procedure in first remission. Reducing relapse risk is an effective way of reducing toxicity and more targeted therapy and improved risk group stratifications are needed.
ISSN:0007-1048
1365-2141
DOI:10.1111/bjh.14419