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RESULTS

LIBYAN EXPERIENCE IN PEDIATRIC ACUTE MYELOID LEUKEMIA Fathia El Riani, Rasem Al Ajnef, Elham Sbita, Salem Zarroug Departement of pediatric hematology-oncology Tripoli Medical Center.

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RESULTS

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  1. LIBYAN EXPERIENCE IN PEDIATRIC ACUTE MYELOID LEUKEMIAFathia El Riani, Rasem Al Ajnef, Elham Sbita, Salem ZarrougDepartement of pediatric hematology-oncology Tripoli Medical Center

  2. MATERIAL AND METHODData were collected from the fills of all children with the diagnosis of acute myeloid leukemia for the period from Jan. 1997 to Dec. 2002Information regarding age ,gender, way of diagnosis , clinical presentation treatment and end result were recorded and analyzed

  3. RESULTS • 39 pts. Were identified • 23 boys and 16 girls • M:F ratio 1.4 : 1 • Mean age 7.1 yrs. ( range 2ms. – 14 yrs. ) • All patients were diagnosed by bone marrow and peripheral blood morphology. according to F.A.B. classifications. • Cytochemical stains.( Sudan black + P.A.S.) was done in some pts.

  4. CLINICAL MANIFESTATION • Symptoms + signspatients • *Pallor 39pts • *Fever 29pts • *Bleeding 25pts • *Proved DIC. 4pts • *Adenopathy 23pts • *Hepatosplenomegaly 15pts • *Gingival hypertrophy 8pts • *Bone pain 8pts • *Chloroma 4pts

  5. HEMATOLOGICAL PARAMETERS No of pts. W.B.C. counts • 15pts. >50.000 (43.6%) • 22pt < 50.000 (56.4% 33.3% <4.000 23% normal • 2pts.> 200.000 ( 5% ) • 4pts has C.N.S. disease at diagnosis

  6. SUB TYPES ACCOURDING TO FAB CLASSIFICATION • Sub typesOur studyFAB • M0 - - • M1 3(7.6) 18% • M2 7 (17.9%) 28% • M3 7(17.9%) 28% • M4 9(23.7%) 27% • M5 7((17.9%) 10% • M6 3(7.6%) 4% • M7 3(7.6%) 5%

  7. TREATMENT • All patient treated with DAT. Protocol • Daunarubicin 45mg/m2/iv daily for 3days • Cytarabine 100 mgs /m2 iv continuous infusion over 24hrs for 7 days • 6Thioguanine 100 mgs /m2 p.o. daily for 7 days • IT ( M.T.X +Ara c + HCT. )

  8. Consolidation • 1ST consolidation: • Cytarabine 100mg/m2 /iv infusion over 24hrs daily for /5days • DNR 45mg/m2 / d/ iv/ daily for 2days • 6TG 100mg/m2/d/oral daily for 5 days • IT (MTX + ARA C + HCT )

  9. From the beginning of 2001 • 2nd consolidation: • Cytarabine 100 mg/m2/iv/daily for 5 days • Etoposide 100mg/m2/iv infusion over 2 hrs daily for 5days.

  10. 2gms /m2 /12 hly/ iv infusion daily for 3 days Given as an intensification. High dose cytarabine

  11. Maintenance therapy • Block I • Cytarabine 100 mg/m2/iv/daily for 4ds. • 6TG 100mg/m2/oral/daily for 4 days • I T (MTX+ ARA C + HCT ) • BlockII • Cytarabine 100 mg/m2 iv/daily for 4 days • Etoposide 100 mg/m2/iv infusion over 2hrs daily for 4days Block I alternate with block II every 21 days • Total period of 2 yrs

  12. Treatment result • 32/39 82% attained CR (median duration of remission 13.3ms) • 4 pts. Died during induction • 2 pts. Were refractory • 1 pts. Transferred to another hospital • 22 / 32 relapsed (19 in B.M.+3B.M. and CNS)

  13. TREAMENT 0F RELAPSED PATIENT • All relapsed pts. Received DAT as initial treatment • Etoposide was added to 6 pts. • M-amsacrine was given to 2pts. After DAT failure • Allogenic B.M.T.was done abroad for 2 pts.

  14. Results of treatment of relapsed patients • 13 / 22 (59% ) attained a second remission Median duration of remission 4.6 ms Range(2 ms. - 12 ms.)

  15. DEATHS • Total number of deaths 31pts (79.5% ) • 4 during induction. (infection and bleeding ) • 2 pts. Were refractory to treatment. and died of disease • 3 died in remission • 2 pts. Who had B.M.T. died shortly after transplant • 20pts .died because of disease progression.

  16. Over all • 6 patients are alive (15.4% ) • 4 are off therapy • 2 still on chemotherapy • 2pts are lost for follow up.

  17. CONCLUSION • Our study shows that CR attained in 82% of acute myeloid leukemia treated with conventional dose anthracycline and cytarabine. • The diagnosis were done according to FAB classification morphologically and all pts. treated in the same way regardless of their risk group. • 68.7% (22/32) relapsed and 79.5% diedwhich indicate that our protocol was not effective in maintaining remission. • High dose cytosar did not improve remission duration or survival in our study. • Cytochemical ,cytogenetic and immunophenotyping are necessary to identify risk group. • Change of chemotherapy to more effective drugs. • B.M.T is an alternative treatment for high risk patients .

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