{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:54:17Z","timestamp":1781585657295,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012232","name":"National Key Clinical Specialty Discipline Construction Program of China","doi-asserted-by":"publisher","award":["2021\u201076"],"award-info":[{"award-number":["2021\u201076"]}],"id":[{"id":"10.13039\/501100012232","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Management of pediatric acute megakaryoblastic leukemia (AMKL) without Down syndrome (non\u2010DS\u2010AMKL) remains challenging due to suboptimal induction responses and poor survival. This study assessed the efficacy of fludarabine, cytarabine, granulocyte colony\u2010stimulating factor, and idarubicin (FLAG\u2010IDA) in non\u2010DS\u2010AMKL and evaluated the role of risk\u2010adapted consolidation strategies, including hematopoietic stem cell transplantation (HSCT) during first complete remission (CR1), guided by genetic profiles and measurable residual disease (MRD) dynamics. In this multicenter retrospective study from China, we analyzed 58 non\u2010DS\u2010AMKL patients treated with FLAG\u2010IDA (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200950) or daunorubicin, cytarabine, etoposide (DAE) (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20098) induction, followed by risk\u2010adapted consolidation. FLAG\u2010IDA demonstrated CR rates comparable to those with DAE (first\u2010course: 70.0% vs. 87.5%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.423; cumulative: 82.0% vs. 87.5%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20091.000). Compared with other AML subtypes, non\u2010DS\u2010AMKL showed inferior 5\u2010year overall survival (OS) (61.7% vs. 78.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001) and event\u2010free survival (EFS) (58.5% vs. 68.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.045), attributable to a higher relapse rate (34.8% vs. 19.5%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). High\u2010risk genetics predicted worse outcomes. HSCT in CR1 significantly improved survival for high\u2010risk or poor responders. CR with MRD negativity after second induction predicted superior OS and EFS (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Risk\u2010adapted HSCT and MRD\u2010guided stratification are critical for non\u2010DS\u2010AMKL management.\n                  <\/jats:p>","DOI":"10.1002\/cam4.71879","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T03:49:52Z","timestamp":1779076192000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated Molecular Risk Stratification and Measurable Residual Disease\u2010Guided Consolidation Improve Outcomes in Pediatric Non\u2010Down Syndrome Acute Megakaryoblastic Leukemia"],"prefix":"10.1002","volume":"15","author":[{"given":"Chunxia","family":"Cai","sequence":"first","affiliation":[{"name":"Fujian Provincial Key Laboratory on Hematology, Department of Paeditric Hematology, Fujian Institute of Hematology Fujian Medical University Union Hospital  Fuzhou 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematoloy\/Oncology Guangzhou Women and Children's Medical Center  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangling","family":"He","sequence":"additional","affiliation":[{"name":"Department of Paeditrics People's Hospital of Hunan Province  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Paeditrics The First Affiliated Hospital of Xiamen University  Xiamen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honggui","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Paeditrics Sun Yat\u2010Sen Memorial Hospital, Sun Yat\u2010Sen University  Guangzhou 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7882-5131","authenticated-orcid":false,"given":"Yongzhi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Fujian Provincial Key Laboratory on Hematology, Department of Paeditric Hematology, Fujian Institute of Hematology Fujian Medical University Union Hospital  Fuzhou 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