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Treatment outcome in older patients with childhood acute myeloid leukemia
Jeffrey E Rubnitz1, Stanley Pounds, Xueyuan Cao
1Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. jeffrey.rubnitz@stjude.org
Insights
Outcomes for older children with acute myeloid leukemia (AML) have improved, now matching younger patients. However, toxic deaths remain a concern, necessitating better supportive care alongside novel therapies.
Area of Science:
- Pediatric Hematology Oncology
- Cancer Clinical Trials
- Leukemia Research
Background:
- Older age traditionally associated with poorer prognosis in pediatric acute myeloid leukemia (AML).
- Impact of age relative to other prognostic factors in recent pediatric AML trials was previously unclear.
Purpose of the Study:
- To evaluate the impact of age on outcomes in pediatric acute myeloid leukemia (AML).
- To compare treatment failure causes across different age groups and treatment protocols.
Main Methods:
- Analysis of clinical outcomes and treatment failure in 351 pediatric AML patients.
- Data collected from three consecutive protocols between 1991 and 2008.
- Outcomes analyzed based on patient age and specific treatment protocol.
Main Results:
- Recent protocol (AML02) improved outcomes for patients aged 10–21 years, with event-free survival (EFS) and overall survival (OS) similar to younger patients (birth–9 years).
- Cumulative incidence of refractory leukemia or recurrence (CIR) was comparable between older and younger age groups.
- Significantly higher incidence of toxic death observed in older patients (10–21 years) compared to younger counterparts (13.2% vs. 4.5%).
Conclusions:
- Survival rates for older children with AML have improved and are now comparable to younger patients.
- Toxic deaths represent a significant challenge in older pediatric AML patients.
- Future research should prioritize enhanced supportive care and development of more effective anti-leukemic therapies.
Background:
Older age has historically been an adverse prognostic factor in pediatric acute myeloid leukemia (AML). To the authors' knowledge, the impact of age relative to that of other prognostic factors on the outcome of patients treated in recent trials is unknown.
Methods:
Clinical outcome and causes of treatment failure of 351 patients enrolled on 3 consecutive protocols for childhood AML between 1991 and 2008 were analyzed according to age and protocol.
Results:
The more recent protocol (AML02) produced improved outcomes for patients aged 10 years to 21 years compared with 2 earlier studies (AML91 and AML97), with 3-year rates of event-free survival (EFS), overall survival (OS), and cumulative incidence of refractory leukemia or recurrence (CIR) for this group being similar to those of patients aged birth to 9 years: EFS: 58.3% ± 5.4% versus 66.6% ± 4.9% (P = .20); OS: 68.9% ± 5.1% versus 75.1% ± 4.5% (P = .36); and CIR: 21.9% ± 4.4% versus 25.3% ± 4.2% (P = .59). The EFS and OS estimates for patients aged 10 to 15 years overlapped those for patients aged 16 to 21 years. However, the cumulative incidence of toxic death was significantly higher for patients aged 10 to 21 years compared with younger patients (13.2% ± 3.6% vs 4.5% ± 2.0%; P = .028).
Conclusions:
The survival rate for older children with AML has improved on the results of a recent trial and is now similar to that of younger patients. However, deaths from toxicity remain a significant problem for patients in the older age group. Future trials should focus on improving supportive care while striving to develop more effective antileukemic therapy.
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