Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries

Wennström, Lovisa; Edslev, Pernille Wendtland; Abrahamsson, Jonas; Nørgaard, Jan Maxwell; Fløisand, Yngvar; Forestier, Erik; Gustafsson, Göran; Heldrup, Jesper; Hovi, Liisa; Jahnukainen, Kirsi; Jónsson, Òlafur G.; Palle, Josefine; Zeller, Bernward; Holmberg, Erik; Juliusson, Gunnar; Stockelberg, Dick; Hasle, Henrik

doi:10.1002/pbc.25713

Cited by 19 publications

(19 citation statements)

References 40 publications

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“…However, since APL is extremely rare in children, the inclusion of children is an unlikely explanation for these differences. 33 The most frequent cause of ED in our cohort was multiorgan failure, sepsis, and DIC, while intracranial bleeding was the dominant cause of death during the first week after diagnosis. Considering the population-based setting, the observed EDR of 18% is relatively low compared to previous reports.…”

Section: Discussionmentioning

confidence: 75%

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Addressing the room for improvement in management of acute promyelocytic leukemia

Nørgaard

Friis

Kristensen

et al. 2019

European J of Haematology

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Acute promyelocytic leukemia (APL) is highly curable. To achieve high cure rates, targeted therapy with retinoic acid (ATRA) must be started promptly at time of suspected diagnosis. Early death rates (EDRs, ≤30 days from diagnosis) differ markedly in patients treated on clinical trials compared to the general population. Objectives and methods: We used the comprehensive Danish National AcuteLeukemia Registry (DNLR) to investigate the incidence, treatment, EDR, and longterm clinical outcome in APL between 2000 and 2014.Results: Twenty-two of 41 deaths occurring in 122 APL patients were EDs which were primarily caused by intracranial hemorrhage, disseminated intravascular coagulation (DIC), sepsis, and multiorgan failure. The overall EDR was 18.0%, whereas clinical trial participants had an EDR of 6.7%. Fifteen patients recruited to the NCRI AML17 APL trial from 2010 to 2013 were younger and had decreased mortality (HR 0.18, CI 0.04-0.86, P = 0.02) compared to contemporarily treated patients (n = 15) not recruited to a clinical trial. Performance status, leukemia origin, and Sanz-score were independent prognostic variables. Conclusions:The very low EDR for on-trial patients is not observed in the general cohort of APL patients. Diagnostic awareness emerges as the greatest clinical challenge in management of APL. K E Y W O R D Sacute promyelocytic leukemia, diagnostic awareness, early death, prognosis

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Section: Discussionmentioning

confidence: 75%

“…Apart from being of more mixed ethnic composition, the two North American studies included children. However, since APL is extremely rare in children, the inclusion of children is an unlikely explanation for these differences …”

Section: Discussionmentioning

confidence: 99%

Addressing the room for improvement in management of acute promyelocytic leukemia

Nørgaard

Friis

Kristensen

et al. 2019

European J of Haematology

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“…Three other studies compared outcomes of AYA patients with AML who were treated using either a pediatric or an adult protocol. The results were somewhat contradictory; while the German and American studies demonstrated better event-free survival and OS rates with the pediatric protocol, a Nordic study found the opposite [4,6,9]. However, all 3 studies showed increased…”

Section: Discussionmentioning

confidence: 99%

“…Multivariate Analysis of OS, DFS, RR, and TRM in the recent recipients cohort TRM with the pediatric protocols, indicating that intensive pediatric frontline therapy was too toxic for AYA patients with AML. Even fewer studies examined allogeneic HSCT: the National Marrow Donor Program and the Center for International Blood and Marrow Transplant Research conducted 1 such study and the University of Minnesota conducted another [9,10]. The National Marrow Donor Program/Center for International Blood and Marrow Transplant Research study compared HSCT outcomes among children, AYA, and older adults and reported the highest survival rate in children followed by AYAs, with the worst outcomes in older adults.…”

Section: Tablementioning

confidence: 99%

“…Evidence is increasingly showing the superiority of the pediatric approach for the management of AYA patients with ALL. However, the data on AML are very limited [3] and only a few retrospective studies of AYA patients with AML have compared pediatric and adult approaches [4][5][6][7][8][9]. Although allogeneic hematopoietic stem cell transplantation (HSCT) is an important curative option for both children and adults with AML, only a few reports have examined the procedure in AYA patients with AML [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Allogeneic Hematopoietic Stem Cell Transplantation for Adolescents and Young Adults with Acute Myeloid Leukemia

Tomizawa

Tanaka

Kondo

et al. 2017

Biology of Blood and Marrow Transplantation

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Few reports have focused on adolescent and young adult (AYA) patients with acute myeloid leukemia (AML) treated with hematopoietic stem cell transplantation (HSCT). We performed a retrospective analysis based on data obtained from a Japanese nationwide registration database to compare HSCT outcomes in AYA patients with AML with those in children with AML. An analysis of the 2973 patients with de novo AML who received allogeneic HSCT from 1990 to 2013 showed inferior 5-year overall survival (OS) (54% versus 58%, P <.01) and increased treatment-related mortality (TRM) (16% versus 13%, P = .02) in AYA patients. Multivariate analysis for both OS and TRM showed a significant negative impact on AYAs. However, the negative impact of older age lost its significance in an additional analysis focusing on 1407 recent transplant recipients with high-resolution HLA typing (2000 to 2013). Finally, we analyzed the impact of transplantation center type on HSCT outcomes in 317 adolescent patients (15 to 18 years old) and found no difference in outcomes between patients treated at a pediatric or an adult hospital. Higher age was a strong predictive factor for inferior OS resulting from increased TRM, which can be eliminated with better donor selection using high-resolution HLA typing.

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Intracellular aggregations of biological elements: From simple to complex

Lan

Liang

2021

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Most cellular elements could be functioned by forming aggregate structures through interactions with other molecules, which is like the luminescence mechanism of AIE molecules. However, in comparison to AIE molecules, the aggregation of biological elements appears to be more complex due to membership and mechanism, which is in line with the trend in biological evolution following the principle of simplicity to complexity. Here, we chose three distinctive examples because they differ significantly in their composition and show a progression from simple to complex, namely protein–protein complexes, protein–nucleic acid complexes, and protein–nucleic acid–lipid complexes. The majority of units that perform functions within cells belong to these three types. We discuss the formation mechanisms and related functions of the protein–protein complex (PML‐NB), the proteins–nucleic acids complex ribosome, and the proteins–nucleic acids–lipids complex exosome, and hope to provide expert insight for related fields.

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Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries

Abstract: No difference was found in outcome for AML patients age 10-30 years treated according to pediatric as compared to adult protocols.

Cited by 19 publications

References 40 publications

Addressing the room for improvement in management of acute promyelocytic leukemia

Addressing the room for improvement in management of acute promyelocytic leukemia

Allogeneic Hematopoietic Stem Cell Transplantation for Adolescents and Young Adults with Acute Myeloid Leukemia

Intracellular aggregations of biological elements: From simple to complex

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