Epidemiology and Survival Analysis of Acute Myeloid Leukemia among Children over the last 20 years

Abstract

AML is a clonal disorder caused by malignant transformation of a bone marrow-derived, self-renewing stem cell or progenitor, which demonstrates a decreased rate of self-destruction as well as aberrant differentiation. These events lead to increased accumulation in the bone marrow and other organs by these malignant myeloid cells. AML shows great variability in clinical course and response to therapy, as well as in the genetic and molecular basis of the pathology. Our goal in this study was to evaluate the clinico-epidemiological aspects of pediatric AML in Ain Shams Pediatric Oncology Unit over a 20 years period, the associated risk factors and the survival rates. This retropspective study included 59 AML patients diagnosed in the Hematology and Oncology Unit at Children's hospital, Ain Shams University in the period from July 1995 till July 2015. Data was collected from files and or care givers including full medical history for age, gender of the patient, positive family history, residency, age of onset of the disease, presenting clinical picture, BM aspirate results, flowcytometry, cytogenetics results. Occurence of complications (febrile neutropenia, fungal infections, CNS complications and cardiac complications). Evaluation of protocol of treatment and treatment response (remission, relapse rate, progression and death rate and causes of death) was evaluated and 1, 3 and 5 years event free and overall survival rates were calculated. Their age ranged from 15 days to 15 years (mean 6.5 ± 4.6 years) with most of the patients being less than 5 years (50.8%), 25.4% between 6-10 years and 23.7% > 10 years, they were 30 females (50.8%) and 29 males(49.2%). Most of them (78.0%) were residents of Greater Cairo. Six cases in our study had positive family history. Fever was the most common symptom at diagnosis in our study (66.2%). While, (35.6%) presented with pallor, (20.3%) with bleeding disorders, (17%) with hepatosplenomegaly, (6.8%) had eye proptosis and (3.4%) had myeloid sarcoma. In our series, Most of cases had FAB M2 (35.6%). While, the least in frequency was FAB M5 (1.7%) , none were diagnosed with FAB M6 morphology. In our study, Patients with AML and normal karyotype; cytogenetically normal (CN-AML) constitute the largest cytogenetic group of AML (39%). We report favorable cytogenetics in (18.6%) of our patients, this included t(8;21) [16.9%] and inversion (16) [1.7%]. (8.5%) of our AML patients had Down syndrome, all had M7 FAB subtype.