Risk factors and prognosis analysis of acute myeloid leukemia in children

To explore the efficacy and related prognostic factors of acute myeloid leukemia (AML) in children except acute promyelocytic leukemia (APL).

The clinical data of 89 non-APL children with AML treated in our hospital were retrospectively analyzed. The remission status was analyzed after chemotherapy, the long-term survival was evaluated using the Kaplan-Meier method, and the influencing factors for the prognosis were detected using univariate and multivariate Cox regression analyses.

Complete remission (CR) was realized in 71 cases (79.8%) after the first course of treatment, 13 cases (14.6%) after the second course of treatment, and 5 cases (5.6%) after the third course of treatment. The 5-year event-free survival (EFS) rate and overall survival (OS) rate were 53.9% and 66.3%, respectively. The children were divided into low-risk group (n=31), middle-risk group (n=36) and high-risk group (n=22). In the three groups, the 5-year OS rate was 74.2%, 72.2% and 45.5%, respectively, while the 5-year EFS rate was 67.7%, 55.6% and 31.8%, respectively. Extramedullary infiltration at the time of initial diagnosis [HR=3.313 (95% CI: 1.748-13.664)], CD56+ [HR=1.592 (95% CI: 1.172-2.255)] and recurrence time <1 year [HR=3.040 (95% CI: 1.087-5.508)] were independent risk factors affecting the prognosis, and CR achieved after the first course [HR=0.786 (95% CI: 0.228-0.803)] was an independent factor improving the prognosis of patients.

The prognosis is poor in non-APL children with AML who have extramedullary infiltration at the time of initial diagnosis, CD56+ and recurrence time <1 year, and CR achieved after the first course is an independent factor improving the prognosis of patients. The long-term EFS rate is significantly lower in high-risk group than that in low- and middle-risk groups. Intensive chemotherapy or early hematopoietic stem cell transplantation should be performed for high-risk patients.