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Children who remain leukemia-free 5 years after diagnosis considered cured
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Children who remained in complete remission from acute myeloid leukemia for at least 4 years from the time of diagnosis were at low risk for relapse, and those who remained in complete remission up to 5 years can be considered cured, study results suggest.
“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,” Jeffrey E. Rubnitz, MD, PhD, of the department of oncology at St. Jude Children’s Research Hospital, and colleagues wrote.
Jeffrey E. Rubnitz
Rubnitz and colleagues sought to determine whether children with AML would maintain long-term remission after the completion of therapy. They assessed cumulative risk for relapse, time to relapse, EFS and OS in 604 children included in seven consecutive clinical trials grouped into three treatment eras. Era 1 covered 1976 to 1991; era 2 covered 1991 to 1997; and era 3 covered 2002-2008.
Overall, 292 patients included in the study were alive and in remission at the end of the study period.
Median time to relapse was 0.93 years during era 1, 0.76 years during era 2 and 0.8 years during era 3 (P=.22). The risk for relapse decreased significantly over time, declining from 52.6% in era 1 to 31.5% during era 2 and 22% during era 3 (P<.001).
The likelihood for relapse among children in remission 4 years from diagnosis was 1.7% during era 1, 2.9% during era 2 and 0.9% during era 3. During the most recent era, 43 of the 44 relapses occurred within 4 years of diagnosis.
“These milestones should reduce the anxiety and fears that patients and their parents experience at the time of cessation of therapy and at subsequent clinic visits,” Rubnitz and colleagues wrote. “These data might also help patients overcome the barriers to insurance coverage and health care access often experienced by long-term survivors.”
Disclosure: The study was funded in part by a grant from the NIH and the American Lebanese Syrian Associated Charities.
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