Paediatric Acute Myeloid Leukaemia; Clinical Characteristics and Treatment Outcome; Experience From a Developing Country

Abstract

Objective: To document the demographics and treatment outcome of Paediatric Acute Myeloid Leukaemia (AML) at a tertiary care facility of Pakistan. Methods: The prospective descriptive study conducted at the Paediatric Oncology department, Combined Military Hospital (CMH) Rawalpindi, Pakistan. All newly registered cases of AML under eighteen years of age from 1 st January 2012 onwards who completed their treatment before 30 th September 2018 were included. Results: Data of 187 cases of De novo AML, including 117 (62.6 %) males and 70 (37.4 %) females was analysed. The mean age was 6.1 ± 3.53 years. The most common presenting features were pallor 156 (83.4%), fever 143 (76.5%) & bruising/bleeding 95 (50.8 %). Sixty-six (35.3 %) patients had WBC >50x10 9 /L at presentation. The most common FAB subtype was M-2 in 85 (45.5 %), followed by M-4 in 25 (13.4 %) cases. The overall treatment related mortality (TRM) was 55/187 (29.4%). The major causes of TRM were neutropenic sepsis and bleeding. Sixty patients had refractory or relapsed disease and 53 (88.3%) of them also died. Total 121 patients completed full treatment. OS and DFS of these 121 patients were 65.3 % and 59.5% respectively. Conclusions: This is the largest study of Paediatric AML from Pakistan. High TRM, primarily during induction chemotherapy and relapsed/refractory disease are the major causes of treatment failure. AML-M2 has the best survival rates. Malnutrition, high WBC counts at presentation and unfavourable cytogenetics have decreased OS and DFS rates. Use of Etoposide during induction chemotherapy does not give any survival advantage.