Significance of age in acute myeloid leukemia patients younger than 30 years

Abstract

BACKGROUND. Data on the impact of age in acute myeloid leukemia (AML) patients <30 years treated in pediatric and adult trials are scarce. METHODS. In all, 891 patients <18 years were treated in the pediatric trials AML‐BFM 93/98 and 290 adolescents and young adults (>16 to <30 years) in the AMLCG 92/99 and AMLSG HD93/98A trials. Treatment schedules and dose intensities were comparable. RESULTS. Initial features and risk factors differed considerably between infants (<2 years) and older age groups and only slightly between children (2 to <13), adolescents (13 to <21) and young adults (21 to <30). Treatment results were most favorable in children (5‐year event free survival [EFS]: 54% ± 3%), slightly inferior in adolescents (46% ± 4%, P = .03), and unfavorable in young adults (28% ± 5%, P = .0001). Excluding patients with favorable karyotypes, the results were similar in infants and children (EFS: 44% ± 4% and 46% ± 3%, respectively) and inferior in adolescents (35% ± 4%) and young adults (23% ± 4%). There was an increased, age‐related percentage and inferior outcome in patients with >5% bone marrow blasts after induction. EFS was especially poor in young adults, with blasts >5%. The blast count after induction was of no prognostic value in patients with favorable karyotypes, but a significant risk factor in patients with other cytogenetics. CONCLUSIONS. Biologic data differed mainly between infants and older age groups. When comparing the same age groups, outcome was similar between the trial groups, which differed from reports concerning acute lymphoblastic leukemia. However, the prognosis decreased after childhood independent of other risk factors. This indicates that even in the younger cohorts increasing age may be an additional unfavorable factor. Cancer 2008. © 2007 American Cancer Society.

MiR-99a may serve as a potential oncogene in pediatric myeloid leukemia

“…With the rapid development of modern combination chemotherapy and hematopoietic stem cell transplantation, 5-year event-free survival for pediatric acute lymphoblastic leukemia (ALL) has been improved to rates as high as 80% [20,21]. However, the prognosis of pediatric AML is still poor, with long-term survival rates of about 50% to 65% [22]. The overall survival of CML was recently reported to be up to 80% at 8 years of follow-up in respondent patients due to the introduction of imatinib (a tyrosine kinase inhibitor) [23], there still remains a subset of patients who fail the treatment.…”

Treatment of Acute Myeloid Leukemia in Adolescent and Young Adult Patients

“…Notably, the therapy should be to cure the patient by exterminating the leukemic clone while avoiding side effects and late effects as much as possible. In acute lymphoblastic leukemia, it has been shown that poorer prognosis of AYAs can be overcome with intensive pediatric protocols; whether a similar approach should be applied to AYAs with AML is not evidently provided [2]. Despite several strategies to increase the intensity of therapy, the long-term overall survival rate has not exceeded a plateau of 50%, suggesting that treatment-related toxicity does not balance against antileukemic efficacy [9].…”

“…Acute myeloid leukemia (AML) represents about 33% of adolescent and 50% adult leukemia [2]. In United States, using 1975–2011 US Surveillance Epidemiology and End Results (SEER) data, annual rates for new diagnosis of AML in AYAs are 4.4/100,000, but survival data for the specific age groups of AYA are scarce.…”

“…In United States, using 1975–2011 US Surveillance Epidemiology and End Results (SEER) data, annual rates for new diagnosis of AML in AYAs are 4.4/100,000, but survival data for the specific age groups of AYA are scarce. Although population-based data from England and Wales 1993–1998 years showed a five-year survival of 46%, while US SEER 1975–2000 years registry data showed a 20-year survival of 20%–27% for 15–29-year-old AYA with AML [2]. …”

Acute Myeloid Leukemia in Adolescents and Young Adults: Challenging Aspects

“…In a large survey evaluating the age effect on AML biology and response to therapy among pediatric patients [29], a clearly defined pattern was reported in the infancy age, but a distinct biology of AYAs could not be clearly identified. Large prospective studies that included both pediatric and adult patients did not report any special consideration or outcome for AYAs [30,31].…”