AML-321: Childhood Acute Myeloid Leukemia (AML), Patient Profile, and Outcome at the National Institute of Children San Borja (INSN-SB) Lima, Peru

Abstract

Childhood AML represents 15% of leukemias and is the most difficult cancer to treat due to its heterogeneity, high relapse rate, extramedullary disease, mortality related to chemotoxicity, and associated infections. We have the challenge of facing difficulties of health access and basal nutrition status. This is a cohort of 49 consecutive AML cases at INSN-SB in Lima-Peru from January 2014 to May 2020. We excluded Down's syndrome AML and patients who did not receive any chemotherapy treatment because they were critically ill at the time of diagnosis. Among the 49 cases, we analyzed 36 intention-to-treat cases under the BFM 2004 protocol according stratification risk. The median age was 5.7 years (range 0.4–15,7), F/M ratio 3/2, median time from initial symptoms to admission was 28 days (range 5–60), and 66.7% came from remote provinces. We classified as standard risk 25%, high risk 22.2%, and very high risk 52.8%. According to basal nutritional status, 30.6% of children had weight-based malnutrition and 19.4% had protein malnutrition. The transcription factor AML1-ETO was detected in 25% and 38.5% together with granulocytic sarcoma. We detected abnormal karyotype in 19 (52.8%), diploid in 14 (38.9%), and not available in 3 cases (8.3%). Median LDH was 1016 UI/dL (range 81–5453) for all the cohort but 3 cases. Complete response (CR) rate after induction was 55.6%; among the 20 response cases, 9 relapsed Eight cases underwent allogenic bone marrow transplantation (BMT) after induction therapy, of whom 3 relapsed. Induction response was higher for those younger than 5.7 years old (X2=5.4 p=0.05) and AML1-ETO detected cases (X2=4.56, p=0.064). Overall survival (OS) was 16.23±6.12 months for the entire analyzed cohort, and median disease-free survival (DFS) was 58.93±25.07 months for the CR group. DFS was not influenced by any of the variables studied. OS was higher for the BMT group (45.8±9.6 vs 21.2±4.8; log rank 4.107, p=0.043). Our cohort showed a low CR rate with high relapse rate, and it appears that induction followed by BMT assures higher OS.