Differences in Outcomes of Newly Diagnosed Acute Myeloid Leukemia for Adolescent/Young Adult and Younger Patients A Report from the Children's Oncology Group

• Type of Material: Article
• Authors: Jason Canner, Advocate Hope Children's Hospital; Todd A. Alonzo, University of Southern California; Janet Franklin, Children's Oncology Group; David R. Freyer, Children's Hospital Los Angeles; Alan Gamis, Children’s Mercy Hospitals and Clinics; Robert B. Gerbing, University of Southern California; Beverly J. Lange, Children's Hospital of Philadelphia; Soheil Meshinchi, Fred Hutchinson Cancer Research Center; William G Woods, Emory University; John Perentesis, Cincinnati Children's Hospital Medical Center; John Horan, Emory University
• Language: English
• Date: 2013-12-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.28342
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 119
• Issue: 23
• Start Page: 4162
• End Page: 4169
• Grant/Funding Information: Supported in part by the AYA Cancer Research Program of the Aflac Foundation/CureSearch for Children's Cancer; and by grants from the National Institutes of Health (U10 CA98543 and U10 CA98413).
• Keywords: REMISSION; adolescent and young adult; children; TRIAL; THERAPY; AML; cancer; infection; Science & Technology; AGE; CHEMOTHERAPY; acute myeloid leukemia; Oncology; Life Sciences & Biomedicine; MUTATIONS
• Research Categories: Health Sciences, Oncology

Abstract

BACKGROUND Studies comparing survival of adolescent and young adult (AYA) patients to that of younger patients with newly diagnosed acute myeloid leukemia (AML) have yielded conflicting results. In order to more accurately characterize relative survival and other outcomes of AYA patients, a cross-study analysis was conducted using data from recent trials conducted by the Children's Cancer Group (CCG) and Children's Oncology Group (COG). METHODS Data were combined from the CCG-2891, CCG-2941, CCG-2961, and AAML03P1 trials. The data set included 1840 patients, comprising 238 AYA and 1602 younger patients. RESULTS Overall survival was not significantly different in the 2 groups (AYA, 49% ± 7% versus younger, 54% ± 3% (± 2 standard errors), P =.058). Relapse was lower in AYA patients (30% ± 7% versus 41% ± 3%, P =.002), but treatment-related mortality (TRM) was higher (25% ± 6% versus 12% ± 2%, P <.001). After adjustment for other factors, older age remained strongly associated with TRM (hazard ratio = 2.30, 95% CI = 1.59-3.33, P <.001). Infection accounted for the excess TRM in AYA patients. CONCLUSIONS Survival in AYA and younger patients with newly diagnosed AML is similar; however, older patients are at higher risk for TRM. More effective strategies for preventing mortality from infection in AYA patients are needed.