Blood Res 2018; 53(1): 25-34  https://doi.org/10.5045/br.2018.53.1.25
Improvement of treatment outcome over 2 decades in children with acute myeloid leukemia
Tae Yang Song1, Sang Hoon Lee1, Gun Kim1, Hee Jo Baek1,2, Tai Ju Hwang1, Hoon Kook1,2
1Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 2Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea
Correspondence to: Hoon Kook, M.D., Ph.D. Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea E-mail: hoonkook@chonnam.ac.kr
Received: July 17, 2017; Revised: August 30, 2017; Accepted: September 21, 2017; Published online: March 31, 2018.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background The prognosis of pediatric acute myeloid leukemia (AML) has recently improved. This study aimed to describe the epidemiology, changes in treatment strategies, and improvement of outcomes in Gwangju-Chonnam children with AML over 2 decades. Methods Medical records of 116 children with newly diagnosed AML were retrospectively reviewed for demographic characteristics, prognostic groups including cytogenetic risks, treatment protocols, and survival rates over the periods between 1996 and 2005 (Period I, N=53), and 2006 and 2015 (Period II, N=38). Results The annual incidence of AML has decreased with reduced pediatric population. The 5-year Kaplan-Meier (K-M) estimated overall survival (OS) and event-free survival (EFS) rates in 110 AML patients were 53.2±5.1% and 43.8±5.1%, respectively. The 5-year OS rate significantly improved during period II (70.3±7.0%) as compared to that during period I (40.0±6.8%) (P =0.001). The 5-year OS was not significantly different among cytogenetic risk groups (P =0.11). Fifty-eight patients underwent hematopoietic stem cell transplantation (HSCT). The K-M 5-year estimated survival for transplanted patients was 53.7±7.0%, while that for chemotherapy-only patients was 30.1±9.1% (P =0.014). Among the prognostic factors, treatment modality was the only independent factor. The chemotherapy-only group had a relative risk of 2.06 for death compared with the transplantation group (P=0.015). Conclusion The survival of Korean children with AML has improved to a level comparable with that of developed countries over 2 decades, owing to a change in induction strategy, better supportive care with economic growth, refinement of HSCT techniques including a better selection of patients based on prognostic groups, and stem cell donor selection.
Keywords:
Acute myeloid leukemia, Cytogenetics, Child, Hematopoietic stem cell transplantation, Survival rate


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