Abstract
Introduction. Results from St. Jude and M. D. Anderson, USA, suggested that AML children < 10 years have significantly better outcome than patients aged 10–21 years. Similarly, the Medical Research Council, UK, showed superior survival in children < 10 years due to a lower relapse rate compared to 10 – 15 year olds. We describe the AML outcome by age in the Nordic countries.
Patients. Within the population based NOPHO AML protocols (NOPHO-AML 93 and NOPHO-AML 2004) we treated 403 patients aged 0 – 18 years from 1993 – 2007. Patients with Down syndrome and AML-M3 were excluded. The children were divided into three age groups; 0 –1 year (27%), 2 –9 years (41%) and 10+ years (32%). The oldest age group had a male preponderance. MLL-aberrations were more common among the youngest and t(8;21) among the oldest. FAB-type M5 was seen in 35% of 0–1 year olds versus only in 16% of children aged 10+.
| . | 0 – 1 year n= 109 . | 2 –9 years n = 165 . | 10 – 18 years n = 129 . | . |
|---|---|---|---|---|
| Boys/girls | 44/67 = 0.67 | 80/87 = 0.94 | 80/49 = 1.63 | p = 0.01 |
| WBC>100×109/L | 18 (17%) | 14 (9%) | 18 (14%) | p = 0.10 |
| Cytogenetics t(8;21) t(9;11) Other MLL | 1 (1%) 14 (13%) 21 (19%) | 24 (15%) 12 (7%) 16 (10%) | 15 (12%) 9 (7%) 9 (7%) | p = 0.01 p = 0.39 p = 0.03 |
| FAB type M4 M5 | 22 (20%) 38 (35%) | 32 (19%) 31 (19%) | 26 (20%) 21 (16%) | p = 0.96 p = 0.00 |
| Protocol NOPHO-AML 93 NOPHO-AML 04 | 75 (25%) 34 (32%) | 125 (42%) 40 (37%) | 96 (32%) 33 (31%) | p = 0.4 |
| . | 0 – 1 year n= 109 . | 2 –9 years n = 165 . | 10 – 18 years n = 129 . | . |
|---|---|---|---|---|
| Boys/girls | 44/67 = 0.67 | 80/87 = 0.94 | 80/49 = 1.63 | p = 0.01 |
| WBC>100×109/L | 18 (17%) | 14 (9%) | 18 (14%) | p = 0.10 |
| Cytogenetics t(8;21) t(9;11) Other MLL | 1 (1%) 14 (13%) 21 (19%) | 24 (15%) 12 (7%) 16 (10%) | 15 (12%) 9 (7%) 9 (7%) | p = 0.01 p = 0.39 p = 0.03 |
| FAB type M4 M5 | 22 (20%) 38 (35%) | 32 (19%) 31 (19%) | 26 (20%) 21 (16%) | p = 0.96 p = 0.00 |
| Protocol NOPHO-AML 93 NOPHO-AML 04 | 75 (25%) 34 (32%) | 125 (42%) 40 (37%) | 96 (32%) 33 (31%) | p = 0.4 |
Results. Almost half of the patients experienced events during follow-up. Types of events, event-free survival (EFS), and overall survival (OS) are shown in the table.
| . | 0 – 1 year n= 109 . | 2 –9 years n = 165 . | 10 – 18 years n = 129 . | . |
|---|---|---|---|---|
| Induction death | 2 (2%) | 4 (2%) | 3 (2%) | p = 0.9 |
| Resistant disease | 2 (2%) | 2 (1%) | 9 (7%) | p = 0.01 |
| Death in CR | 6 (6%) | 4 (2%) | 8 (6%) | p = 0.2 |
| Relapse | 34 (31%) | 64 (39%) | 42 (33%) | p = 0.4 |
| 5-year EFS | 57% | 54% | 48% | p = 0.5 |
| 5-year OS | 68% | 68% | 64% | p = 0.7 |
| . | 0 – 1 year n= 109 . | 2 –9 years n = 165 . | 10 – 18 years n = 129 . | . |
|---|---|---|---|---|
| Induction death | 2 (2%) | 4 (2%) | 3 (2%) | p = 0.9 |
| Resistant disease | 2 (2%) | 2 (1%) | 9 (7%) | p = 0.01 |
| Death in CR | 6 (6%) | 4 (2%) | 8 (6%) | p = 0.2 |
| Relapse | 34 (31%) | 64 (39%) | 42 (33%) | p = 0.4 |
| 5-year EFS | 57% | 54% | 48% | p = 0.5 |
| 5-year OS | 68% | 68% | 64% | p = 0.7 |
Conclusion. Older children are more often male, more frequently have t(8;21) and less often M5-subtype or MLL-aberrations. The OS and EFS are similar among all ages. However, older children more often have resistant disease. The risk of death during induction and relapse is similar.
Disclosures: No relevant conflicts of interest to declare.
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