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Definition of cure in childhood acute myeloid leukemia
Author(s) -
Rubnitz Jeffrey E.,
Inaba Hiroto,
Leung Wing H.,
Pounds Stanley,
Cao Xueyuan,
Campana Dario,
Ribeiro Raul C.,
Pui ChingHon
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28742
Subject(s) - medicine , cumulative incidence , myeloid leukemia , incidence (geometry) , adverse effect , complete remission , cancer , pediatrics , quality of life (healthcare) , chemotherapy , cohort , physics , nursing , optics
BACKGROUND A better understanding of when cure can be declared in childhood acute myeloid leukemia (AML) would reduce anxiety and improve quality of life of AML survivors. The authors determined the likelihood that patients with AML would maintain long‐term remission after the completion of therapy. METHODS The cumulative risk of relapse, the time to relapse, event‐free survival, and overall survival were analyzed for 604 patients with AML who were enrolled in 7 successive clinical trials divided into 3 treatment eras (1976‐1991, 1991‐1997, and 2002‐2008). RESULTS The median time to relapse did not change over time (0.93 years vs 0.76 years vs 0.8 years, respectively, for each consecutive era; P = .22), but the risk of relapse decreased significantly (5‐year cumulative incidence of relapse: 52.6% ± 3.1% vs 31.5% ± 3.9% vs 22% ± 3%, respectively, for each consecutive era; P < .001). Among patients who were in remission 4 years from diagnosis, the probabilities of relapse were 1.7%, 2.9%, and 0.9%, respectively, for each consecutive era. In the most recent era, all but 1 of 44 relapses occurred within 4 years of diagnosis. CONCLUSIONS Children with AML who receive treatment with contemporary therapy and remain in remission 4 years from diagnosis probably are cured. Although late relapses and late deaths from other causes are rare, long‐term follow‐up of survivors is necessary for the timely management of late adverse effects. Cancer 2014;120:2490–2496. © 2014 American Cancer Society .