Improvement of treatment outcome over 2 decades in children with acute myeloid leukemia

Abstract

BackgroundThe prognosis of pediatric acute myeloid leukemia (AML) has recently improved. This study aimed to describe the epidemiology, changes in treatment strategies, and improvement of outcomes in Gwangju-Chonnam children with AML over 2 decades.MethodsMedical records of 116 children with newly diagnosed AML were retrospectively reviewed for demographic characteristics, prognostic groups including cytogenetic risks, treatment protocols, and survival rates over the periods between 1996 and 2005 (Period I, N=53), and 2006 and 2015 (Period II, N=38).ResultsThe annual incidence of AML has decreased with reduced pediatric population. The 5-year Kaplan-Meier (K-M) estimated overall survival (OS) and event-free survival (EFS) rates in 110 AML patients were 53.2±5.1% and 43.8±5.1%, respectively. The 5-year OS rate significantly improved during period II (70.3±7.0%) as compared to that during period I (40.0±6.8%) (P =0.001). The 5-year OS was not significantly different among cytogenetic risk groups (P =0.11). Fifty-eight patients underwent hematopoietic stem cell transplantation (HSCT). The K-M 5-year estimated survival for transplanted patients was 53.7±7.0%, while that for chemotherapy-only patients was 30.1±9.1% (P =0.014). Among the prognostic factors, treatment modality was the only independent factor. The chemotherapy-only group had a relative risk of 2.06 for death compared with the transplantation group (P=0.015).ConclusionThe survival of Korean children with AML has improved to a level comparable with that of developed countries over 2 decades, owing to a change in induction strategy, better supportive care with economic growth, refinement of HSCT techniques including a better selection of patients based on prognostic groups, and stem cell donor selection.

Outcomes of pediatric acute myeloid leukemia patients with FLT3-ITD mutations in the pre-FLT3 inhibitor era

“…In this study, the OS, EFS, and RFS were 53.8±12.1%, 53.6±12.1%, and 72±12%, respectively, showing a significant improvement in outcomes for pediatric AML patients with FLT3-ITD mutations over a period of 2 decades. This improvement in outcomes was also seen in other follow-up studies of AML patients with FLT3-ITD mutations owing to advances in general medical care and aggressive treatment strategies, including earlier HSCTs [3,5,8]. The CR rate after first-line induction therapy was 72.2% (13/18 patients) and the CR rate after salvage therapy was 80% (4/5 patients).…”

“…Acute myeloid leukemia (AML) is a heterogeneous hematological malignancy that involves the uncontrolled clonal proliferation of blasts in the bone marrow and peripheral blood. It is characterized by clonal evolution and genetic heterogeneity [ 1 - 3 ]. Since cytogenetic profiles have become important indicators of prognosis in AML, the World Health Organization, National Comprehensive Cancer Network, and European LeukemiaNet have incorporated certain cytogenetic and molecular abnormalities in AML classifications and risk stratifications.…”

Retrospective analysis of children with high‐risk acute myeloid leukemia who underwent allogeneic hematopoietic stem cell transplantation following complete remission with initial induction chemotherapy in the AML‐05 clinical trial

“…The survival of children with acute myeloid leukemia (AML) has substantially improved in the past two decades due to intensified chemotherapy and better supportive care modalities . Induction chemotherapy consisting of cytarabine and anthracyclines with or without etoposide is adopted in most clinical trials.…”

Flow-Cytometric Monitoring of Minimal Residual Disease in Pediatric Patients With Acute Myeloid Leukemia: Recent Advances and Future Strategies

“…In the last few decades, significant progress has been obtained in the outcome of pedAML, with an increase of survival rate up to 70% (2). The results depend on the improvement in risk stratification including genetic features at diagnosis, intensification of chemotherapy together with the amelioration of supportive care, and application of hematopoietic stem cell transplantation (HSCT) to specific subgroups of patients (3, 4). Nevertheless a large amount of patients (20–41%) encounters relapse, with non-acceptable final outcome in about 50–70% of them (5–13).…”