Treatment outcome in older patients with childhood acute myeloid leukemia

Authors

  • Jeffrey E. Rubnitz MD, PhD,

    Corresponding author
    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    • Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Mail Stop 260, Memphis, TN 38105-2794

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    • Fax: (901) 521-9005

  • Stanley Pounds PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Xueyuan Cao PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Laura Jenkins BS,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Gary Dahl MD,

    1. Division of Hematology/Oncology, Lucile Packard Children's Hospital, Stanford Cancer Center, Palo Alto, California
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  • W. Paul Bowman MD,

    1. Division of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas
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  • Jeffrey W Taub MD,

    1. Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan
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  • Ching-Hon Pui MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    3. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Raul C. Ribeiro MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Dario Campana MD, PhD,

    1. Department of Paediatrics, National University of Singapore, Singapore
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  • Hiroto Inaba MD, PhD

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Abstract

BACKGROUND.

Older age has historically been an adverse prognostic factor in pediatric acute myeloid leukemia (AML). To the authors' knowledge, the impact of age relative to that of other prognostic factors on the outcome of patients treated in recent trials is unknown.

METHODS.

Clinical outcome and causes of treatment failure of 351 patients enrolled on 3 consecutive protocols for childhood AML between 1991 and 2008 were analyzed according to age and protocol.

RESULTS.

The more recent protocol (AML02) produced improved outcomes for patients aged 10 years to 21 years compared with 2 earlier studies (AML91 and AML97), with 3-year rates of event-free survival (EFS), overall survival (OS), and cumulative incidence of refractory leukemia or recurrence (CIR) for this group being similar to those of patients aged birth to 9 years: EFS: 58.3% ± 5.4% versus 66.6% ± 4.9% (P = .20); OS: 68.9% ± 5.1% versus 75.1% ± 4.5% (P = .36); and CIR: 21.9% ± 4.4% versus 25.3% ± 4.2% (P = .59). The EFS and OS estimates for patients aged 10 to 15 years overlapped those for patients aged 16 to 21 years. However, the cumulative incidence of toxic death was significantly higher for patients aged 10 to 21 years compared with younger patients (13.2% ± 3.6% vs 4.5% ± 2.0%; P = .028).

CONCLUSIONS.

The survival rate for older children with AML has improved on the results of a recent trial and is now similar to that of younger patients. However, deaths from toxicity remain a significant problem for patients in the older age group. Future trials should focus on improving supportive care while striving to develop more effective antileukemic therapy. Cancer 2012. © 2012 American Cancer Society.

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