Blood Res.  2018 Mar;53(1):25-34. 10.5045/br.2018.53.1.25.

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

• Song TY
• Lee SH
• Kim G
• Baek HJ
• Hwang TJ
• Kook H

• KMID: 2414361
• DOI: http://doi.org/10.5045/br.2018.53.1.25

Abstract

BACKGROUND
The 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.
METHODS
Medical 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).
RESULTS
The 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).
CONCLUSION
The 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.

Keyword

Acute myeloid leukemia; Cytogenetics; Child; Hematopoietic stem cell transplantation; Survival rate

MeSH Terms

Child*
Clinical Protocols
Cytogenetics
Developed Countries
Disease-Free Survival
Donor Selection
Economic Development
Epidemiology
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Leukemia, Myeloid, Acute*
Medical Records
Prognosis
Retrospective Studies
Stem Cells
Survival Rate
Treatment Outcome*

Figure

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  Fig. 1 Flow diagram of patients.

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  Fig. 2 Annual incidence of newly diagnosed pediatric acute myeloid leukemia.

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  Fig. 3 The 5-year Kaplan-Meier estimated (K-M) overall survival (OS) (A) and event-free survival (EFS) (B) for 110 childhood acute myeloid leukemia cases acute promyelocytic leukemia. The OS (C) and EFS (D) were compared according to study period.

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  Fig. 4 The 5-year Kaplan-Meier overall survival (K-M OS) (A) and event-free survival (EFS) (B) for 91 childhood acute myeloid leukemia cases, excluding acute promyelocytic leukemia. The OS (C) and EFS (D) were compared according to study period.

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  Fig. 5 The 2-year Kaplan-Meier overall survival (K-M OS) (A) and event-free survival (EFS) (B) for 91 childhood acute myeloid leukemia cases by induction regimen.

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  Fig. 6 The 5-year Kaplan-Meier overall survival (K-M OS) (A) and event-free survival (EFS) (B) for 91 childhood acute myeloid leukemia cases by cytogenetic prognostic group.

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  Fig. 7 The 5-year Kaplan-Meier overall survival (K-M OS) for 91 childhood acute myeloid leukemia cases by treatment modality.

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  Fig. 8 The 5-year Kaplan-Meier overall survival (K-M OS) by stem cell sources.

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