Prognostic Factors in Childhood Acute Myeloid Leukemia; Experience from A Developing Country

Ghafoor, Tariq; Khalil, Sumaira; Farah, Tanzeela; Ahmed, Shakeel; Sharif, Imtenan

doi:10.1002/cnr2.1259

Cited by 7 publications

(13 citation statements)

References 21 publications

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“…Factors such as late presentation, malnutrition, and TRM were reported to be contributing. 29 We encountered a much better outcome in our AML patients, with an 8-year OS of 63.5%, which was very close to the statistics of developed countries. The 8-year EFS was 43%, which is mostly attributed to the high relapse rate in childhood AML despite intensive chemotherapy.…”

Section: Discussionsupporting

confidence: 86%

“…However, in resource‐limited countries, survival is still much lower with OS and EFS below 40%. Factors such as late presentation, malnutrition, and TRM were reported to be contributing 29 . We encountered a much better outcome in our AML patients, with an 8‐year OS of 63.5%, which was very close to the statistics of developed countries.…”

Section: Discussionsupporting

confidence: 82%

“…If a patient with leukemia has normal ESR, it may indicate the rapid progression of the illness and insufficient time to raise ESR. The same concept is relevant in children with normal hemoglobin levels at presentation which was found to be associated with lower OS in AML 29 . Other variables such as high WBC counts, malnutrition, unfavorable cytogenetics, resistant disease to induction chemotherapy, and high body mass index were reported to correlate with poor outcomes in some reports 29,38 …”

Section: Discussionmentioning

confidence: 93%

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The survival of childhood leukemia: An 8‐year single‐center experience

et al. 2023

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Background The survival of childhood leukemia has improved. We aimed to report the survival rate and the associated factors in children with acute leukemia during an 8‐year follow‐up. Aims This study investigates the 8‐year survival rates of children with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in Shiraz, the largest oncology center in Southern Iran. We also aimed to assess the independent factors associated with higher mortality in childhood leukemia. Methods Children 0–18 years with acute leukemia were followed from 2013 to 2021 in Shiraz, Iran. The 8‐year overall survival (OS) and event‐free survival (EFS) rates were estimated by the Kaplan–Meier method. Independent factors associated with survival were assessed by the Cox regression hazard modeling. Results We included 786 children, with 43.5% female, and a mean age of 6.32 ± 4.62 years. Patients with AML compared to ALL experienced more relapse (34.6% vs. 22.5%, p = .01) and death (31.7% vs. 11.3%, p < .001). The cumulative 8‐year OS and EFS were 81% (95% confidence interval (CI), 74.3% to 86.1%) and 68.3% (95% CI, 63.5% to 72.7%) in ALL patients and 63.5% (95% CI, 52.1% to 72.9%) and 43% (95% CI, 33.1% to 52.6%) in AML patients. Multivariable analysis revealed that hepatomegaly (hazard ratio = 4, 95% CI, 1.0 to 22.3, p = .05) was the main independent risk factor of death in ALL patients. No definite risk factor was defined for AML patients. Conclusion The survival of childhood leukemia has recently increased dramatically in low‐middle income countries. Hepatomegaly was introduced as a potential risk factor for lower survival in ALL patients. Further multicenter studies are needed to confirm the validity of this association.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 93%

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The survival of childhood leukemia: An 8‐year single‐center experience

et al. 2023

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“…Several other biological and non-biological factors not evaluated in the present study could be contributing to this poor outcome. For instance, a late presentation, malnutrition, high treatment-related mortality, low SES, and high treatment abandonment rates have been recognized ( 49 ). The SES analysis performed, based on the mother years of study as an SES indicator, no statistically significant association was detected between CEBPA POS positive cases and a low SES ( p = 0.99) or between a low SES and a poor outcome (death) ( p = 0.76; Results of the analysis are shown in Supplementary Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Mutational Landscape of CEBPA in Mexican Pediatric Acute Myeloid Leukemia Patients: Prognostic Implications

et al. 2022

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BackgroundIn Mexico, the incidence of acute myeloid leukemia (AML) has increased in the last few years. Mortality is higher than in developed countries, even though the same chemotherapy protocols are used. CCAAT Enhancer Binding Protein Alpha (CEBPA) mutations are recurrent in AML, influence prognosis, and help to define treatment strategies. CEBPA mutational profiles and their clinical implications have not been evaluated in Mexican pediatric AML patients.Aim of the StudyTo identify the mutational landscape of the CEBPA gene in pediatric patients with de novo AML and assess its influence on clinical features and overall survival (OS).Materials and MethodsDNA was extracted from bone marrow aspirates at diagnosis. Targeted massive parallel sequencing of CEBPA was performed in 80 patients.ResultsCEBPA was mutated in 12.5% (10/80) of patients. Frameshifts at the N-terminal region were the most common mutations 57.14% (8/14). CEBPA biallelic (CEBPABI) mutations were identified in five patients. M2 subtype was the most common in CEBPA positive patients (CEBPAPOS) (p = 0.009); 50% of the CEBPAPOS patients had a WBC count > 100,000 at diagnosis (p = 0.004). OS > 1 year was significantly better in CEBPA negative (CEBPANEG) patients (p = 0.0001). CEBPAPOS patients (either bi- or monoallelic) had a significantly lower OS (p = 0.002). Concurrent mutations in FLT3, CSF3R, and WT1 genes were found in CEBPAPOS individuals. Their contribution to poor OS cannot be ruled out.ConclusionCEBPA mutational profiles in Mexican pediatric AML patients and their clinical implications were evaluated for the first time. The frequency of CEBPAPOS was in the range reported for pediatric AML (4.5–15%). CEBPA mutations showed a negative impact on OS as opposed to the results of other studies.

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“…A recently published study demonstrates incidence, prognostic factors and outcomes of childhood acute myeloid leukemia (AML). 6 Unfortunately, no large study is published from Pakistan which demonstrates the distribution of childhood acute leukaemia. It is important to know the trends in our population and identify differences from other regional and western populations with respect to acute leukaemia subtypes and immunophenotypic profile.…”

Section: Introductionmentioning

confidence: 99%

Distribution of subtypes and immunophenotypic characterization of 1379 cases of paediatric acute leukaemia

et al. 2021

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Objectives: Acute leukaemia is the most common and highly curable childhood malignancy; subtyping and identification of antigens via immunophenotyping helps in treatment plan as well as minimal residual disease monitoring. Methods: This retrospective study was conducted at the Haematology section of the clinical laboratories of Ziauddin University Hospital and The Indus Hospital, Karachi conducted at January 1st, 2012 to December 31st, 2017. The study included 1379 cases of de novo acute leukemia from 2012 to 2017. Among these, 80% were diagnosed by using four color flowcytometry (FACS Calibur), 9% and 11% via immunohistochemistry on bone marrow trephine biopsy samples and morphological examination respectively. Results: The mean age of patients was 7.4 ± 4.3 years while male to female ratio was 1.75:1. Lymphoblastic leukaemia accounted for 77.2% and myeloid leukaemia 21.2%. Amongst lymphoblastic lineage, B-ALL was 80.4% while T-ALL was 19.6%. Among the phenotypic expression of B-ALL, CD79a (99.8%) had the highest positivity. In B-ALL, CD13 (29.8%) was the most common aberrant myeloid marker. Aberrant expression of CD79a observed in 11.1% of T-ALL cases. In non APL AML, aberrant expression of CD79a and CD19 was observed in 6.6% and 5.5% of cases respectively. Conclusion: Overall immunophenotypic profile, expression of aberrant phenotypes and subtype distribution in our patients was similar to international literature except for a relatively high frequency of T-ALL which was discordant from the western data. doi: https://doi.org/10.12669/pjms.37.3.3552 How to cite this:Jamal S, Meraj F, Mansoor N, Parveen S, Shaikh A, Jabbar N. Distribution of subtypes and immunophenotypic characterization of 1379 cases of paediatric acute leukaemia. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3552 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Prognostic Factors in Childhood Acute Myeloid Leukemia; Experience from A Developing Country

Cited by 7 publications

References 21 publications

The survival of childhood leukemia: An 8‐year single‐center experience

The survival of childhood leukemia: An 8‐year single‐center experience

Mutational Landscape of CEBPA in Mexican Pediatric Acute Myeloid Leukemia Patients: Prognostic Implications

Distribution of subtypes and immunophenotypic characterization of 1379 cases of paediatric acute leukaemia

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