Outcome of adolescent patients with acute myeloid leukemia treated with pediatric protocols

Abstract

As past studies of adolescent and young adults (AYA) with acute myeloid leukemia (AML) reported conflicting results, we conducted a retrospective analysis using data from three Japanese pediatric AML studies. Among the 782 patients with de novo AML, 44 were classified as AYA (age ≥15 years at diagnosis), 164 as infants (0-1 year), 413 as younger children (2-11 years), and 161 as older children (12-14 years). While the 5-year event-free survival rate of AYA was not different among the groups, the five-year survival rate (54.7 %) was significantly lower than that of the other three groups (P = 0.019): 68.7 % for infants, 73.2 % for younger children, and 75.5 % for older children. No difference in the 5-year cumulative incidence of relapse was observed, but treatment-related death (TRD) of AYA was significantly higher (29.4 %) than that in infants (14.8 %), younger children (10.2 %), and older children (13.8 %). Multivariate analysis showed age ≥15 years old at diagnosis was associated with both poor survival rate and high TRD. Adolescents with AML had inferior survival due to a higher incidence of TRD, especially after failure of initial frontline treatment.

Acute myelogenous leukemia in adolescents and young adults

“…Similar findings were reported for TRM rates in patients aged 10–21 years in the St. Jude Children's Research Hospital AML protocols (1991–2008) . Survival rates for Japanese patients aged 15–17 years were lower than those for younger patients, mainly due to a higher TRM rate after relapse …”

“…45 Survival rates for Japanese patients aged 15-17 years were lower than those for younger patients, mainly due to a higher TRM rate after relapse. 46…”

Treatment strategies for adolescent and young adult patients with acute myeloid leukemia

“…In multivariate analysis, they demonstrated that age $15 years is associated with a nearly threefold increase in the risk for TRM (hazard ratio [HR] 5 2.789; 95% confidence interval [CI], 1.437-5.412; P 5 .002). 6 Studies from the COG have also highlighted the high risk for TRM among AYA patients. In an analysis encompassing 4 COG trials (Children's Cancer Study Group [CCG] 2891, CCG 2941, CCG 2961, and AAML 03P1) and 1840 patients, Canner et al compared outcomes in patients 16 to 20 years of age to those in younger patients.…”

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

“…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].…”