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Childhood AML : Prognosis

Prognostic factors in children and adolescents with acute myeloid leukemia (excluding children with Down syndrome and acute promyelocytic leukemia): univariate and recursive partitioning analysis of patients treated on Pediatric Oncology Group (POG) Study 8821

Leukemia volume 14, pages 1201–1207 (2000)Cite this article

Abstract

The purpose of the paper was to define clinical or biological features associated with the risk for treatment failure for children with acute myeloid leukemia. Data from 560 children and adolescents with newly diagnosed acute myeloid leukemia who entered the Pediatric Oncology Group Study 8821 from June 1988 to March 1993 were analyzed by univariate and recursive partitioning methods. Children with Down syndrome or acute promyelocytic leukemia were excluded from the study. Factors examined included age, number of leukocytes, sex, FAB morphologic subtype, cytogenetic findings, and extramedullary disease at the time of diagnosis. The overall event-free survival (EFS) rate at 4 years was 32.7% (s.e. = 2.2%). Age ⩾2 years, fewer than 50 × 109/l leukocytes, and t(8;21) or inv(16), and normal chromosomes were associated with higher rates of EFS (P value = 0.003, 0.049, 0.0003, 0.031, respectively), whereas the M5 subtype of AML (P value = 0.0003) and chromosome abnormalities other than t(8;21) and inv(16) were associated with lower rates of EFS (Pvalue = 0.0001). Recursive partitioning analysis defined three groups of patients with widely varied prognoses: female patients with t(8;21), inv(16), or a normal karyotype (n = 89) had the best prognosis (4-year EFS = 55.1%, s.e. = 5.7%); male patients with t(8;21), inv(16) or normal chromosomes (n = 106) had an intermediate prognosis (4-year EFS = 38.1%, s.e. = 5.3%); patients with chromosome abnormalities other than t(8;21) and inv(16) (n = 233) had the worst prognosis (4-year EFS = 27.0%, s.e. = 3.2%). One hundred and thirty-two patients (24%) could not be grouped because of missing cytogenetic data, mainly due to inadequate marrow samples. The results suggest that pediatric patients with acute myeloid leukemia can be categorized into three potential risk groups for prognosis and that differences in sex and chromosomal abnormalities are associated with differences in estimates of EFS. These results are tentative and must be confirmed by a large prospective clinical trial.

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Acknowledgements

We thank JC Jones for editorial assistance and, Julie Nucci, Martha Sopfe and Pearl Barber for secretarial assistance. The participating Pediatric Oncology Group (POG) institutions and their Principal Investigators are listed in the appendix. This work was supported in part by Grants from the National Institute of Health and the National Cancer Institute, Bethesda, MD (CA-30969, CA-29139, CA-31566, CA-29691, CA-25408, CA-32053, CA-03161, CA-29293, CA-41573, CA-21765) and the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. Pediatric Oncology Group Statistical Office, University of Florida, Gainesville, Florida, USA

    M Chang

  2. St Jude Children's Research Hospital, Memphis, Tennessee, USA

    SC Raimondi

  3. Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, Michigan, USA

    Y Ravindranath

  4. Department of Human Genetics, University of Alabama at Birmingham, Alabama, USA

    AJ Carroll

  5. Midwest Children's Hospital, Milwaukee, Wisconsin, USA

    B Camitta

  6. Baylor College of Medicine, Houston, Texas, USA

    MV Gresik & CP Steuber

  7. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

    H Weinstein

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Chang, M., Raimondi, S., Ravindranath, Y. et al. Prognostic factors in children and adolescents with acute myeloid leukemia (excluding children with Down syndrome and acute promyelocytic leukemia): univariate and recursive partitioning analysis of patients treated on Pediatric Oncology Group (POG) Study 8821. Leukemia 14, 1201–1207 (2000). https://doi.org/10.1038/sj.leu.2401832

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