Treatment and outcome of infants with acute myeloid leukemia

We read with interest the article reporting the results of the Japan Infant Leukemia Study Group treatment of infants with acute myeloid leukemia (AML) on the ANLL91 protocol. The event-free survival reported for their patients treated with intensive chemotherapy is quite impressive.1 The authors were very thorough in comparing their results with those of other cooperative groups. Unfortunately, they did not use the most recently published data from the US Children's Cancer Group (CCG) in their Table 3.1 The updated results of CCG-2891,2published in January 2001, report the responses of 116 infants treated with allogeneic bone marrow transplant, autologous bone marrow transplant, or chemotherapy alone. Those infants achieved an 8-year actuarial survival of 71% (allogeneic transplant), 40% (autologous transplant), and 61% (intensive chemotherapy).2 These numbers are significantly different from the results published in 1996, and compare quite favorably with those reported by Kawasaki et al (72%-74% 3-year survival for a total of 35 patients). While the use of the more recently published CCG results does not change substantively the results or conclusions reached by Kawasaki et al, comparison with the more recent results provides a more appropriate context for evaluating the significance of their findings. These studies complement each other, providing evidence that an age of younger than 1 year is probably not an independent adverse prognostic factor for children with AML, supporting the use of intensive chemotherapy when there is no allogeneic bone marrow donor available.