Treatment Outcome of Paediatric Acute Myeloid Leukemia: An Experience at Tertiary Care Oncology Unit

Shagufta Naz; Tariq  Ghafoor; Sumaira  Khalil; Qudratullah  Malik; Faisal  Basheer; Farooq  Ikram

doi:10.51253/pafmj.v75iSUPPL-5.5639

Authors

Shagufta Naz Department of Pediatrics, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Tariq Ghafoor Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Sumaira Khalil Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Qudratullah Malik Department of Pediatrics, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Faisal Basheer Department of Pediatrics, Combined Military Hospital Bhawalpur/National University of Medical Sciences (NUMS) Pakistan
Farooq Ikram Department of Pediatrics, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-5.5639

Keywords:

Acute Myeloid Leukemia (AML), Clinical Features, Pediatrics

Abstract

Objective: To determine the clinical characteristics and treatment outcome of Acute Myeloid Leukaemia (AML) inPaediatric population in a tertiary care hospital.

Study Design: Prospective longitudinal study

Place and Duration of Study: Pediatric Oncology Ward, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Aug 2019.

Methodology: Inclusion criteria: Newly diagnosed patients of Acute myeloid leukemia under 18 years, admitted to paediatric oncology ward in CMH, from 1st September 2018 to 31st August 2019.

Exclusion criteria: Children above 18 years, those getting treatment from other hospitals and who left treatment.

Results: Data of 33 patients with Acute myeloid leukemia including 24(72.7%) males and 9(27.3%) females was analysed. Majority of children (39.4%)were less than 5 years of age. The most common presenting feature was fever in 27(81.8%) followed by pallor in 25(75.8%) cases. High WBC(>50x109/l) count was observed in 8(24.2%) patients. The most common French-American-British Acute myeloid leukemia Subtype M2 was seen in 16(48.5%).

Treatment-related mortality (TRM) was 7(21.2%) with neutropenic sepsis as the major cause. After a median follow-up of 9 months, OS was 18(54.5%) and DFS was 17(51.5%).

Conclusion: High Treatment related mortality was observed during induction chemotherapy and maximum remission was seen in patients with AML-M2 subtypes and favourable cytogenetics. Malnutrition and high WBC count at presentation were poor prognostic factors.

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References

1 Song TY, Lee SH, Kim G, Baek HJ, Hwang TJ, Kook H. Improvement of treatment outcome over 2 decades in children with acute myeloid leukaemia. Blood Res 2018; 53(1): 25-34.

2 Handschuh L. Not Only Mutations Matter: Molecular Picture of Acute Myeloid Leukemia Emerging from Transcriptome Studies. J Oncol 2019; 11(55): 1-36.

3 Pievani A, Biondi M, Tomasoni C, Biondi A, Serafini M. Location First: Targeting Acute Myeloid Leukemia Within Its Niche. J Clin Med 2020; 8; 9(5): 1513.

4 Brent A, Williams, Law A, Hunyadkurti J, Desilets S, Jenrey V. Review Antibody Therapies for Acute Myeloid Leukemia: Unconjugated, Toxin-Conjugated, Radio-Conjugated and Multivalent Formats. J Clin Med 2019; 8(8): 1261.

5 Burnett AK, Russell NH, Hills RK, Hunter AE, Kjeldsen L, Yin J, et al. Optimization of chemotherapy for younger patients with acute myeloid leukemia: Results of the medical research council AML15 trial. J Clin Oncol 2013; 31(27): 3360-3368.

6 Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2017; 129(4): 424–447.

7 Horowitz M, Schreiber H, Elder A, Heidenreich O, Vormoor J, Vago L, et al. Epidemiology and biology of relapse after stem cell transplantation. Bone Marrow Transpl 2018; 53(11): 1379–1389.

8 Karol SE, Coustan-smith E, Cao X, Shurtleff SA, Riamondi SC, Choi JK, et al. prognostic facorts in children with acute myeloid leukemia and excellent response to remission induction chemotherapy. Br J Haematol 2015; 168(1): 94-101.

9 Taga T, Tomizawa D, Takahashi H, Adachi S. Acute myeloid leukemia in children: Current status and future directions. Pediatr Int 2016; 58(2): 71-80.

10 Wennstrom L, Edslev PW, Abrahamsson J, Norgaard JM, Floisand Y, Forestier E, et al. Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries. Pediatr Blood Cancer 2016; 63(1): 83-92.

11 Hassan H, Goddard K, Howrd AF. Utility of number needed to treat in peadiatric haematological cancer randomised controlled treatment trials: a systemic review. BMJ open 2019; 9: e022839.

https://doi.org/10.1136/bmjopen-2018-022839

12 Williams LA, Richardson M, Marcotte EL, Poynter JN, Spector LG. Sex ratio among childhood cancers by single year of age. Pediatr Blood Cancer 2019; 66(6): e27620.

13 Shaikh MS, Ahmed ZA, Shaikh MU, Adil SN, Khurshid M, Moatter T, et al. Distribution of Chromosomal Abnormalities Commonly Observed in Adult Acute Myeloid Leukemia in Pakistan as Predictors of Prognosis. Asian Pac J Cancer Prev 2018; 19(7): 1903-1906.

14 Fadoo Z, Mushtaq N, Alvi S, Ali M. Acute myeloid leukaemia in children: experience at a tertiary care facility of Pakistan. J Pak Med Assoc 2012; 62(2): 125-128.

15 Rubnitz JE, Inaba H. Childhood acute myeloid leukaemia. Br J Haematol 2012; 159(3): 259-276.

16 Imamura T, Wamoto S, Kanai R. Outcome in 146 patients with pediatric acute myeloid leukemia treated according to the AML 99 protocol in the period 2003-06 from the Japan Association of Childhood Leukemia Study. Br J Heamatol 2012; 159(2): 204-210.

17 Liu LP, Zhang AL, Ruan M, Chang LX, Liu F, Chen X, et al. Prognostic stratification of molecularly and clinically distinct subgroup in children with acute monocytic leukemia. Cancer Med 2020; 9(11): 3647-3655.

18 Klein K, Kaspers G, Harrison CJ. clinical impact of additional cytogenetic abberations, cKIT and ras mutations and treatment in pediatrict(8;21)-AML; results from an International Retrospective Study by the International Berlin-Frankfurt-Munster Study Group. J Cling Oncol 2015; 33(36): 4247-4258.

19 De Kouchkovsky I, Abdul-Hay M. 'Acute myeloid leukemia: a comprehensive review and 2016 update'. Blood Cancer J 2016; 6(7): e441.

20 Inaba H, Surprise HC, Pounds S, Cao X, Howard SC, Ringwald Smith K, et al. Effect of body mass index on the outcome of children with acute myeloid leukemia. Cancer 2012; 118(23): 5989-5996.

21 Vedi A, Mitchell R, Shanmuganathan S, Oswald C, Marshall GM, Trahair T, et al. Increased Survival for children with acute myeloid leukemia Results From Improved Postrelapse Treatment. J Pediatr Hematol Oncol 2018; 40(7): 541-547.

22 Creautzig U, Zimmermann M, Reinhardt D, Dworzak M, Staiy J, LehrnbecharT. Early deaths and treatment related mortality in Children undergoing therapy for Acute Myeloid Leukemia: Analysis of multicentre clinical trials in AMLBFM 93 and AML - BFM 98. J Clin Oncol 2004; 22(21): 4384-4393.

23 Arber DA, Stein AS, Carter NH, Ikle D, Forman SJ, Slovak ML. Prognostic impact of acute myeloid leukemia classification. Importance of detection of recurring cytogenetic abnormalities and multilineage dysplasia on survival. Am J Clin Pathol 2003; 119(5): 672-680.

24 Von-NeuhoffC, Reinhardt D, Sander A. Prognostic impact of specific chromosomal aberrations in a large group of pediatric patients with acute myeloid leukemia treated uniformly according to trial AML-BFM 98. J Clin Oncol 2010; 28(16): 2682-2689.