Treatment outcome in older patients with childhood acute myeloid leukemia

Jeffrey E. Rubnitz, Stanley Pounds, Xueyuan Cao, Laura Jenkins, Gary Dahl, W. Paul Bowman, Jeffrey W. Taub, Ching Hon Pui, Raul C. Ribeiro, Dario Campana, Hiroto Inaba

Research output: Contribution to journalArticle

25 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)6253-6259
Number of pages7
JournalCancer
Volume118
Issue number24
DOIs
StatePublished - Dec 15 2012
Externally publishedYes

Fingerprint

Acute Myeloid Leukemia
Disease-Free Survival
Survival
Poisons
Incidence
Treatment Failure
Leukemia
Survival Rate
Age Groups
Parturition
Pediatrics
Recurrence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Rubnitz, J. E., Pounds, S., Cao, X., Jenkins, L., Dahl, G., Bowman, W. P., ... Inaba, H. (2012). Treatment outcome in older patients with childhood acute myeloid leukemia. Cancer, 118(24), 6253-6259. https://doi.org/10.1002/cncr.27659

Treatment outcome in older patients with childhood acute myeloid leukemia. / Rubnitz, Jeffrey E.; Pounds, Stanley; Cao, Xueyuan; Jenkins, Laura; Dahl, Gary; Bowman, W. Paul; Taub, Jeffrey W.; Pui, Ching Hon; Ribeiro, Raul C.; Campana, Dario; Inaba, Hiroto.

In: Cancer, Vol. 118, No. 24, 15.12.2012, p. 6253-6259.

Research output: Contribution to journalArticle

Rubnitz, JE, Pounds, S, Cao, X, Jenkins, L, Dahl, G, Bowman, WP, Taub, JW, Pui, CH, Ribeiro, RC, Campana, D & Inaba, H 2012, 'Treatment outcome in older patients with childhood acute myeloid leukemia', Cancer, vol. 118, no. 24, pp. 6253-6259. https://doi.org/10.1002/cncr.27659
Rubnitz JE, Pounds S, Cao X, Jenkins L, Dahl G, Bowman WP et al. Treatment outcome in older patients with childhood acute myeloid leukemia. Cancer. 2012 Dec 15;118(24):6253-6259. https://doi.org/10.1002/cncr.27659
Rubnitz, Jeffrey E. ; Pounds, Stanley ; Cao, Xueyuan ; Jenkins, Laura ; Dahl, Gary ; Bowman, W. Paul ; Taub, Jeffrey W. ; Pui, Ching Hon ; Ribeiro, Raul C. ; Campana, Dario ; Inaba, Hiroto. / Treatment outcome in older patients with childhood acute myeloid leukemia. In: Cancer. 2012 ; Vol. 118, No. 24. pp. 6253-6259.
@article{2a6131c3a5d74c5c9aadfb7a9359a03e,
title = "Treatment outcome in older patients with childhood acute myeloid leukemia",
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.",
author = "Rubnitz, {Jeffrey E.} and Stanley Pounds and Xueyuan Cao and Laura Jenkins and Gary Dahl and Bowman, {W. Paul} and Taub, {Jeffrey W.} and Pui, {Ching Hon} and Ribeiro, {Raul C.} and Dario Campana and Hiroto Inaba",
year = "2012",
month = "12",
day = "15",
doi = "10.1002/cncr.27659",
language = "English (US)",
volume = "118",
pages = "6253--6259",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "24",

}

TY - JOUR

T1 - Treatment outcome in older patients with childhood acute myeloid leukemia

AU - Rubnitz, Jeffrey E.

AU - Pounds, Stanley

AU - Cao, Xueyuan

AU - Jenkins, Laura

AU - Dahl, Gary

AU - Bowman, W. Paul

AU - Taub, Jeffrey W.

AU - Pui, Ching Hon

AU - Ribeiro, Raul C.

AU - Campana, Dario

AU - Inaba, Hiroto

PY - 2012/12/15

Y1 - 2012/12/15

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84870709830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870709830&partnerID=8YFLogxK

U2 - 10.1002/cncr.27659

DO - 10.1002/cncr.27659

M3 - Article

VL - 118

SP - 6253

EP - 6259

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 24

ER -