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ASCO Educational Book; 2009
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Postremission Management of Acute Myelogenous Leukemia in Children and Adolescents with and without Hematopoietic Stem Cell Transplantation in European and U.S. Study Groups

Ursula Creutzig, MD, PhD, Martin Zimmermann, PhD, Gertjan Kaspers, MD, PhD, and Dirk Reinhardt, MD, PhD

From the Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster, Germany (Dr. Creutzig); the Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany (Dr. Zimmermann); and the Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands (Dr. Reinhardt)

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Prof. Ursula Creutzig, Universitätsklinikum Münster, Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany; e-mail: ursula{at}creutzig.de

Overview: Hematopoietic stem cell transplantation (HSCT) as a treatment option for pediatric patients with acute myelogenous leukemia (AML) in first remission still remains controversial. Different strategies of European and U.S. study groups are reviewed focusing on allogeneic HSCT. Published results were often biased due to patient selection in the different treatment arms. As randomized trials are hardly possible, the least biased method is to compare patients by biologic allocation according to the availability of a donor, as done in the Medical Research Council (MRC), the Berlin-Frankfurt-Münster (BFM), and the Children's Cancer Group (CCG) trials. Results from these European and U.S. study groups are reported. It is generally accepted that patients with the French-American-British (FAB) subtype M3 or with Down syndrome do not need HSCT at first remission. It is also mostly agreed that in patients with low risk, HSCT should be postponed until second remission. In the United States, matched related allogeneic HSCT in first remission is still recommended for the majority of patients with intermediate- or high-risk AML. In Europe, there is a trend to refrain from HSCT at first remission for these patients to preserve this option in case of relapses and thereby to avoid early and late sequelae in the majority of these patients.