Patient selection: pediatric patients <= 18 years of age with de novo AML
Exclusions: Down syndrome or extramedullary sarcoma with < 30% blasts in bone marrow
Mortality rate in study populations: almost 12%
Treatment periods during the 18 months once treatment started:
(1) induction
(2) high-dose cytarabine mitoxantrone
(3) consolidation with daunorubicin or idarubicin
(4) high-dose etoposide
(5) CNS radiation therapy and maintenance therapy
Causes of death during the first 15 days after diagnosis:
(1) bleeding
(2) leukostasis
Risk factors for death during first 15 days:
(1) poor performance status (ECOG 3 or 4)
(2) hyperleukocytosis (>= 200,000 per µL), usually indicating progressive disease
(3) AML type M5 (FAB classification)
Causes of death after first 15 days:
(1) bacterial infections
(2) fungal infections
(3) bleeding (occasional during induction and consolidation phases)
Risk factors for death after first 15 days:
(1) bone marrow aplasia during periods of chemotherapy
Reducing the risk to the patient:
(1) The patient should be managed at a specialized pediatric oncology center.
(2) Prophylaxis and early management of bleeding and infectious complications.
(3) Leukapheresis or exchange transfusion may be helpful in controlling hyperleukocytosis.
