Outcome of children treated for relapsed acute myeloid leukemia in Central America

Area of Science:

• Pediatric Oncology
• Hematology
• Global Health

Background:

• Outcomes for relapsed childhood acute myeloid leukemia (AML) in resource-limited settings are largely undocumented.
• This study investigates survival rates for children with relapsed AML and acute promyelocytic leukemia (APML) in Central America.

Purpose of the Study:

• To examine survival after relapse in children with non-APML and APML in Central America.
• To identify predictors of event-free survival (EFS) and overall survival (OS) in this population.

Main Methods:

• Retrospective evaluation of children diagnosed with first relapse of AML (non-APML) or APML between 1997 and 2011 in Guatemala, Honduras, or El Salvador.
• Analysis of predictors for subsequent EFS and OS.

Main Results:

• 140 children with relapsed AML (non-APML) and 24 with relapsed APML were identified.
• Two-year subsequent EFS and OS for non-APML were low (7.0% and 9.1%, respectively).
• Worse outcomes were linked to Hispanic/Indigenous heritage, high initial white blood cell count, and early relapse (<18 months). Relapsed APML patients had better outcomes (2-year EFS 36.7%, OS 43.4%), but few survived past 3 years. Palliative care was the sole intent for 15.2% of patients.

Conclusions:

• Children with relapsed AML in Central America have a low chance of survival, suggesting palliative strategies should be prioritized.
• Consideration of re-treatment may be appropriate for children with late relapse or APML, as they may experience prolonged remission.