Rubnitz et al identified prognostic factors for survival in a pediatric patient with recurrent acute myeloid leukemia (AML). In general these patients have a guarded to poor prognosis. The authors are from St. Jude's Children's Research Hospital and the University of Tennessee in Memphis.


Patient selection: pediatric AML with relapse/recurrence


Factors associated with better overall survival:

(1) male gender

(2) autologous stem cell transplant before the relapse

(3) stem cell transplant after the relapse

(4) prolonged interval between the initial diagnosis and recurrence (each month conveys a 3% reduction in the risk of death)



• The stem cell transplants after relapse appear to involve allogeneic transplants from matched sibling or matched unrelated donor.

• No specific cutoff for the time interval between diagnosis and recurrence is given. An interval less than 6 months would be associated with poor outcome and more than 2 years would be good. For the implementation I will use >= 12 months (>= 1 year recorded in Table 3, page 159). One alternative would be to consider an interval < 12 months as indicative of worse overall survival. Another alternative is to consider >= 24 as 2 points and 12-23 months as 1 point.


Factors associated with worse overall survival:

(1) FAB M5 or M7 morphology


Factors favoring a second remission:

(1) male gender

(2) FAB M1 morphology


Factors against a second remission:

(1) allogeneic stem cell transplant before relapse (all died within 1 year)


To read more or access our algorithms and calculators, please log in or register.