Younger Age Associated With Better Outcomes in Childhood AML
WESTPORT, CT (Reuters Health) Sept 12 - Younger children experience better overall survival and disease-free survival than older children do after receiving a diagnosis of acute myeloid leukemia (AML), according to a report in the September 15th edition of Blood.
Dr. David Webb from the Great Ormond Street Hospital for Children in London, UK and colleagues compared the presenting features and outcomes of AML in 698 children, younger than 15 years at diagnosis, who participated in two AML trials in the UK.
Younger children were more likely than older children to present with FAB types M5 and M7, they found, and less likely to have favorable cytogenetic features. The youngest children were more likely to have central nervous system involvement at diagnosis. Remission rates and deaths during induction were similar in the different age groups, the report indicates, but resistant disease was less common in the youngest children.
On multivariate analysis, younger children had better overall survival (p = 0.02), event-free survival (p = 0.02), and disease-free survival (p = 0.06), due mainly to a lower relapse rate (p = 0.02), especially in the bone marrow (p = 0.02).
Diarrhea was more severe with treatment in younger children, whereas nausea and vomiting were more common among children ages 10 to 15.
"Younger children may have received relatively more intensive therapy," the authors observe, "and increased treatment intensity is associated with improved disease-free survival in childhood AML. The lack of good pharmacokinetic data to accurately determine dosages indicates the strong need for appropriate studies in this area to guide improvements to the therapeutic ratio."
Noting the higher incidence of diarrhea and marginally higher rate of death during induction, the researchers conclude, nevertheless, that "further dose reductions are inappropriate at this time, but attention to the supportive care needs of very young children must be emphasized."
Reuters Medical News for the Professional/Medscape
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