Evaluation of treatment and prognosis of children with acute myeloid leukemia

AİM: Acute myeloid leukemia (AML) is a clonal heterogeneous disease of hematopoietic tissue characterized by the accumulation of abnormal leukemic blastic cells and disruption of normal blood cell production due to a maturation defect in the myeloid series in the bone marrow. Acute myeloid leukemia has significant mortality and morbidity in children, although complications and inter-patient prognosis are different, although patients receive treatment based on a standard protocol. This is thought to be due to various genetic and environmental factors. The aim of this study was to investigate the demographic characteristics, presence of genetic mutations, infectious characteristics and frequency, cardiovascular complications and other complications on the prognosis of children with acute myeloid leukemia. Material and Methods: Our study was designed retrospectively. The study included 62 patients diagnosed with acute myeloid leukemia in the Department of Pediatric Hematology, Ege University School of Medicine between 2004 and 2018. Age, diagnosis date, birth date, sex, FAB classification, cardiovascular complications, time to start treatment, chemotherapy protocols, relapse rates, bone marrow transplantation rates, molecular and cytogenetic results were evaluated. Results: Fifty seven patients with acute myeloid leukemia were included in the study. The gender distribution of our cases was 52.6% female and 47.4% male. The youngest patient was 1 year old and the oldest patient was 17 years old. The mean age at diagnosis was 10 ± 5.49, and the median age was 9 years. Average age; 15.83 ± 6.19 in female patients and 13.74 ± 5.86 in male patients. The mean white blood cell count of the patients was 49023 ± 72693/mm3 and the median value was 18530/mm3. There were 11 patients with a white blood cell count of more than 100,000/mm3 at the time of diagnosis. The mean hemoglobin concentration of the patients was 7.96 ± 1.64 g/dl and the median value was 7.9 g/dl. There were 11 patients with hemoglobin <7.0 g/dl. The mean platelet count of the patients was 62896 ± 53112/mm3 and the median platelet count was 51700/mm3. Ten patients were found to have platelets <20,000/mm3. The mean bone marrow blast rate of the 57 patients evaluated was 60.89 ± 29.34%. The minimum value was 30%, the maximum value was 100%, and the median value was 64%. The most common subgroup was AML M2 with 19 patients (33.3%). This group was followed by AML M7 (28.1%) with 17 patients and AML M4 with 12 patients (21.1%). In our clinic, 6 (10.5%) of 57 patients had central nervous system involvement. At admission, 4 patients had extramedullary involvement without CNS. Cytogenetic and molecular genetic examination of bone marrow was performed in all 57 patients. No specific translocation specific to AML was detected in the 52.6% (n = 30) patient group. In 26.3% (n = 15) of the patients, translocations with good prognostic characteristics, translocations with moderate prognosis were seen in 5.4% (n = 3), and in 21.1% (n = 12) translocations with poor prognostic characteristics were shown. Of the 57 patients in the study group, 5 (8.8%) AML BFM 98 protocol, 18 (31.6%) AML BFM 2004 protocol and 34 (59.6%) AML BFM 2013 protocol were applied. 20 (35.1%) of the patients with acute myeloid leukemia had remission on the 15th day, 12 (21.1%) on the 28th day, 5 (8.8) on the 33rd day and 7 (12.3%) on the 58th day. Of 57 patients diagnosed, 2 patients could not enter remission. Of 57 patients diagnosed with acute myeloid leukemia, 23 (40.4%) had relapse, with a mean of 8.8 ± 5.2 months from the time of diagnosis. Bone marrow transplantation Allogeneic HSCT was applied in 19 patients (33.3%) from 57 patients and autologous in 1 patient. Conclusion: The survival rates of the patients followed in the AML BFM 2013 protocol were significantly higher compared to the previously used protocols. The complete evaluation of the genetic factors determining the risk groups of the chemotherapy protocol was effective in improving the results. However, survival still remains below expectations. The most negative effect on patient survival is relapse with a rate of 40.4%. The most important factor in the development of relapse is the problem of access to appropriate data. If the patients who require transplantation after chemotherapy can go to transplantation at the appropriate time, relapses will decrease and survival will be improved. Key words: Acute myeloid leukemia, relapse, bone marrow transplantation