1. 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

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

3. RESULTS 39 pts. Were identified 39 pts. Were identified 23 boys and 16 girls 23 boys and 16 girls M:F ratio 1.4 : 1 M:F ratio 1.4 : 1 Mean age 7.1 yrs. ( range 2ms. – 14 yrs. ) 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. 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. Cytochemical stains.( Sudan black + P.A.S.) was done in some pts.

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

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

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

7. TREATMENT All patient treated with DAT. Protocol All patient treated with DAT. Protocol Daunarubicin 45 mg/m 2 /iv daily for 3days Daunarubicin 45 mg/m 2 /iv daily for 3days Cytarabine 100 mgs /m 2 iv continuous infusion over 24hrs for 7 days Cytarabine 100 mgs /m 2 iv continuous infusion over 24hrs for 7 days 6Thioguanine 100 mgs /m 2 p.o. daily for 7 days 6Thioguanine 100 mgs /m 2 p.o. daily for 7 days IT ( M.T.X +Ara c + HCT. ) IT ( M.T.X +Ara c + HCT. )

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

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

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

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

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

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

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

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

16. Over all 6 patients are alive (15.4% ) 6 patients are alive (15.4% ) 4 are off therapy 4 are off therapy 2 still on chemotherapy 2 still on chemotherapy 2pts are lost for follow up. 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. 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. 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% died which indicate that our protocol was not effective in maintaining remission. 68.7% (22/32) relapsed and 79.5% died which indicate that our protocol was not effective in maintaining remission. High dose cytosar did not improve remission duration or survival in our study. High dose cytosar did not improve remission duration or survival in our study. Cytochemical,cytogenetic and immunophenotyping are necessary to identify risk group. Cytochemical,cytogenetic and immunophenotyping are necessary to identify risk group. Change of chemotherapy to more effective drugs. Change of chemotherapy to more effective drugs. B.M.T is an alternative treatment for high risk patients. B.M.T is an alternative treatment for high risk patients.