The results of treatment for childhood acute myelogenous leukemia (AML) have improved considerably during the last ten years. This progress was demonstrated by the two consecutive multicenter studies, AML-BFM-78 and -83, in which almost identical extended multi drug regimes of che motherapy were administered for eight weeks and followed up by two years maintenance. The main difference in the second study was the addition of an eight-day intensive in duction course. Due to this new element, the relapse rate was reduced significantly. Another result of the BFM-83 study was the definition of two risk groups on the basis of standardized treatment, which has lead to a risk-adapted treatment strategy in the third ongoing trial, AML-BFM- 87. This improvement was only possible thanks to the coop eration of pediatricians, physicians, radiotherapists, statisti cians, and especially the staff at the hospitals and reference laboratories. Thus, we would like to thank everyone who has been involved in these studies and hope that they will be further encouraged to improve treatment strategies for AML in children. The coordination, enforcement, and analyses of the stud ies would not have been possible without the financial sup port of the Federal Ministry for Research and Technology of the FRG. We are grateful for the generous contributions supporting this book from Lederle and Farmitalia. Munster, April 1990 Ursula Creutzig Jorg Ritter Gunther Schellong Contents 1 Introduction . . . . .. . . . . . . . . . . . . . . .. . . . 1 ."

Acute leukemia a quite homogenous disease failed to break through the sound barriere of when untreated reveals a substantial hetero unsatisfactory cure rates even in special sub geneity in its response to therapy. While cure groups. While new protocols including more is achieved in a certain proportion of pa effective supportive care show some increase tients other cases prove to be highly resis in the initial response rates and certain im tant. The curability is superior in acute provements in the long-term results, no ben lymphoblastic (ALL) than in acute myeloid eficial effect on the relapse rate during the (AML) leukemia and - within both type- first 1 Y2 years emerged from any of these higher in children as compared to adults. regimens. Thus, high chances for cure are The two age groups and cell types can be presently restricted to children with ALL further subdivided into prognostic groups and to lesser proportions children with by special diagnostic features. Thus, in AML and adults with ALL and AML.