Acute myeloid leukemia (AML) in adolescents and young adults (AYA): The M. D. Anderson Cancer Center (MDACC) experience

Abstract

7051 Background: AML is a heterogeneous group of hematopoietic neoplasms demonstrating clonal proliferation of myeloid precursors and is typically a disease of older adults. Little is known about outcomes of AYA with AML. Methods: We retrospectively analyzed all patients (pts) with AML treated at MDACC from 1965 to 2008. Pts ages 16 to 21 years (yrs) were defined as AYA. Results: Among 3,934 adult AML pts treated during this period, 163 pts (4%) were AYA with median age of 19 yrs. This cohort included 27 (17%) pts with Core Binding Factor (CBF)-AML [inv(16), t(8:21)] and 19 pts (12%) with acute promyelocytic leukemia (APL). Among the other pts, 50% had diploid cytogenetics, 11% had 5 or 7 abnormalities, 39% had other cytogenetic changes. Antecedent hematologic disorders were present in 33 pts (20%). Among 20 evaluated pts, FLT3 internal tandem duplication (ITD) was present in 4 pts and FLT3 kinase domain mutation was found in 2 pts. Complete remission (CR) rates were 89% for CBF AML, 79% for APL, and 75% for all other pts. Median survival for the total cohort was 1.7 yrs with 36% alive at 3 yrs, and median CR duration of 1.3 yrs (30% CR at 3 yrs). Outcome is better for pts with CBF leukemia (3 yr survival 56%, sustained CR 49%) and APL (3 yr survival 51%, sustained CR 36%) compared to other AML (3 yr survival 28%, sustained CR 24%). CR rates have improved from 71% in 1965–1984, to 85% in 1985–1994, and 83% after 1994. Similarly, overall survival (OS) has increased during the same time periods (3-yr survival 18%, 44%, and 53%, respectively) together with CR duration (3 yr CR duration 21%, 32% and 39%, respectively) as early mortality has decreased (11%, 8%, and 4%, respectively). To compare outcomes of AYA with older adults, we focused on those with diploid cytogenetics.CR for pts ages 16–21 was 81%, with 3 yr survival of 46%; for ages 22–45, CR was 75% and 3 yr survival 36%; for ages 46–60 CR was 68% with 3 yr survival 28%; and for pts age greater than 60, CR was 54% with 3 yr survival of 22%. Conclusions: The outcome of AYA pts with AML is significantly better than for older adults with AML. Despite the advances in treatments over time, there is still significant room for improvement, particularly among those AYA with AML other than CBF and APL. Exploration of new treatment options is needed in this patient population. No significant financial relationships to disclose.