{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:56:58Z","timestamp":1772639818801,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T00:00:00Z","timestamp":1611446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The preferred salvage treatment for children with relapsed\/refractory acute myeloid leukemia (R\/R\u2010AML) remains unclear. The combination of cladribine\/Ara\u2010C\/granulocyte\u2010colony stimulating factor and mitoxantrone (CLAG\u2010M) shown promising results in adult R\/R\u2010AML. We aim to investigate the efficacy and safety of CLAG\u2010M versus mitoxantrone\/etoposide\/cytarabine (MEC) or idarubicin\/etoposide\/cytarabine (IEC) in R\/R\u2010AML children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010five R\/R\u2010AML children were analyzed. The overall response rate (ORR), overall survival (OS), and progression\u2010free survival (PFS) at 3\u2010year were documented. Karyotype or mutations status were summarized as different risk groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ORR was achieved in 80% (16\/20) and 51% (18\/35) of patients after one\u2010cycle of CLAG\u2010M and MEC\/IEC treatment (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). The CLAG\u2010M group's OS (66.8%\u00a0\u00b1\u00a016.2% vs. 40.4%\u00a0\u00b1\u00a010.9%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.019) and PFS (52.6%\u00a0\u00b1\u00a013.7% vs. 34.9%\u00a0\u00b1\u00a09.1%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.036) at 3\u2010year was significantly higher than the MEC\/IEC group. In high\u2010risk patients, 33.3% experienced progression of disease (PD) and 22.2% dead in CLAG\u2010M group, while 50% experienced PD and 43.8% dead in MEC\/IEC. When it comes to low\u2010risk group, none of them in CLAG\u2010M experienced PD or death, while up to 50% of patients received MEC\/IEC suffered PD, and all of them died eventually. Similar results were also found in the intermediate\u2010risk group. Surprisingly, the presence of <jats:italic>FLT3\u2010ITD<\/jats:italic> was associated with poor outcome in both groups. The most common adverse events were hematologic toxicities, and the incidence was similar in both group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CLAG\u2010M group demonstrated effective palliation along with acceptable toxicity in R\/R\u2010AML patients. However, patients with <jats:italic>FLT3\u2010ITD<\/jats:italic> may benefit less from CLAG\u2010M, owing to higher PD rate and all\u2010cause mortality than other patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3681","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T06:57:26Z","timestamp":1611557846000},"page":"956-964","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Improved outcome of children with relapsed\/refractory acute myeloid leukemia by addition of cladribine to re\u2010induction chemotherapy"],"prefix":"10.1002","volume":"10","author":[{"given":"Min","family":"Ruan","sequence":"first","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Peng","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ao\u2010Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Quan Qi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian\u2010Feng","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao\u2010Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao\u2010Juan","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen\u2010Yu","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Guo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao","family":"Zou","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Mei","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; Blood Diseases Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-7793","authenticated-orcid":false,"given":"Xiao\u2010Fan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood Diseases Center State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology &amp; 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