Blood Res.  2023 Dec;58(4):181-186. 10.5045/br.2023.2023152.

Treatment outcome and prognostic factors in relapsed pediatric acute myeloid leukemia

• Lee JH
• Ju HY
• Hyun JK
• Kim SJ
• Cho HW
• Lee JK
• Lee JW
• Sung KW
• Yoo KH

• KMID: 2550195
• DOI: http://doi.org/10.5045/br.2023.2023152

Abstract

Background
Despite improved outcomes for pediatric patients with acute myeloid leukemia (AML), the prognosis for relapse remains poor. This study aimed to examine the clinical factors associated with prognosis in relapsed pediatric AML.
Methods
We conducted a chart review of pediatric patients with AML who experienced their first relapse and received treatment at our institution between 2008 and 2019. Risk stratification at diagnosis was performed according to the definition suggested by the ongoing AML 2012 study in Korea, and the clinical factors associated with prognosis were analyzed.
Results
A total of 27 pediatric patients with relapsed AML were identified. The 5-year overall survival (OS) and event-free survival (EFS) rates were 32.9% and 32.9%, respectively. A duration ≥12 months from diagnosis to relapse had a favorable impact on survival outcomes (5-yr OS, 64.0% vs. 15.7%; P =0.007). Patients who achieved complete remission (CR) after 1 course of chemotherapy following relapse (N=15) had a 5-year OS rate of 59.3%, while none of the other patients survived (P＜0.0001). Additionally, the 5-year OS differed significantly based on the risk group at initial diagnosis (62.3% [favorable and intermediate prognosis groups, N=11] vs. 13.3% [poor prognosis group, N=15]; P=0.014).
Conclusion
Patients with a longer duration of CR before relapse, who achieved CR following 1 course of reinduction chemotherapy, and were in the favorable or intermediate prognosis group at diagnosis demonstrated better outcomes. These findings emphasize the importance of tailoring treatment strategies based on the expected prognosis at relapse in pediatric patients with AML.

Keyword

Acute myeloid leukemia; Pediatric; Relapse; Prognosis

Figure

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  Fig. 1 Determination of prognosis groups in AML 2012 trial. Both risk features and treatment response were taken into account in determining the prognostic group. Abbreviations: AMKL, acute megakaryocytic leukemia; CBF, core-binding factor; CR, complete remission; NR, no response; PR, partial response.

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  Fig. 2 Overall survival (OS) and event-free survival (EFS) rates. OS and EFS of all patients with first relapse of pediatric AML (A). Comparisons of OS rates between the early vs. late relapsers (B), those who achieved CR after 1 course of reinduction chemotherapy vs. others (C), and those in the favorable or intermediate prognosis groups (FG+IG) vs. poor prognosis group (PG) (D).

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