Key clinical point: De-escalation of cytarabine exposure by elimination of the fifth chemotherapy course should only be considered in pediatric patients with low-risk acute myeloid leukemia (LR-AML) with favorable cytogenetic/molecular features and negative minimal residual disease (MRD) at the end of first induction (EOI1).
Major finding: Overall, patients who received 4 vs. 5 chemotherapy courses had worse disease-free survival (DFS; hazard ratio [HR] 1.45; P = .009) and relapse risk (HR 1.40; P = .019). However, patients with favorable cytogenetic/molecular features and negative MRD at EOI1 had no difference in DFS ( P = .934) and overall survival ( P = .928) with 4 vs. 5 chemotherapy courses.
Study details: This prospective study assessed 923 pediatric patients with LR-AML treated in either AAML0531 (n = 225; excluding those treated with gemtuzumab ozogamicin) or AAML1031 (n = 698) trials with 4 (79%) or 5 (21%) courses of frontline chemotherapy.
Disclosures: This study was supported by National Clinical Trials Network (NCTN) Operations Center, NCTN Statistics & Data Center, St. Baldrick’s Foundation, Alex’s Lemonade Stand Foundation, and National Heart Lung and Blood Institute. The authors declared no conflicts of interest.
Source: Getz KD et al. Pediatr Blood Cancer. 2021 Sep 2. doi: 10.1002/pbc.29313 .