[Clinical features and prognosis of childhood acute myeloid leukemia with myelodysplasia-related changes]

Zhongguo Dang Dai Er Ke Za Zhi. 2021 Mar;23(3):271-278. doi: 10.7499/j.issn.1008-8830.2009176.
[Article in Chinese]

Abstract

Objective: To study the clinical features and prognosis of childhood acute myeloid leukemia with myelodysplasia-related changes (AML-MRC).

Methods: A retrospective analysis was performed on the medical data of 14 children who were diagnosed with AML-MRC from June 2014 to March 2020, including clinical features, laboratory examination results, and prognosis.

Results: Among the 14 children with AML-MRC, there were 9 boys and 5 girls, with a median age of 11 years (range: 1-17 years), a median leukocyte count of 8.3×109/L [range: (2.0-191.0)×109/L], a median hemoglobin level of 73 g/L (range: 44-86 g/L), and a median platelet count of 75×109/L [range: (4-213)×109/L] at diagnosis. According to the FAB classification, the children with AML-M5 accounted for 71% (10/14). Among the 14 children, 4 had multi-lineage dysplasia (MLD), 2 had a history of myelodysplastic syndrome (MDS), 5 had MDS-related cytogenetic changes, 2 had MLD with MDS-related cytogenetic changes, and 1 had a history of MDS with MLD. The median follow-up time was 10.6 months (range: 0.4-54.4 months) for 14 children, among whom 2 gave up treatment immediately after diagnosis and 12 had an evaluable treatment outcome. The 2-year overall survival (OS) rate was 50%±15%, and the 2-year disease-free survival (DFS) rate was 33%±13%. Of the 12 children, 7 underwent haploidentical hematopoietic stem cell transplantation (HSCT), among whom 5 achieved DFS and 2 died, with a 2-year OS rate of 71%±17% and a 2-year DFS rate of 43%±19%; 5 children underwent chemotherapy alone, among whom 1 achieved DFS, 3 died, and 1 was lost to follow-up, with a 2-year OS rate of 40%±30% and a 2-year DFS rate of 30%±24%. There was no significant difference in the survival condition between the transplantation and chemotherapy groups (P > 0.05).

Conclusions: Childhood AML-MRC is often observed in boys, and AML-M5 is the most common type based on FAB classification. Such children tend to have a poor prognosis. HSCT is expected to improve the poor prognosis of children with AML-MRC. However due to the small number of cases, it is necessary to increase the number of cases for further observation.

目的: 探讨儿童急性髓系白血病伴骨髓增生异常相关改变(AML-MRC)的临床特征及其预后。

方法: 收集2014年6月至2020年3月确诊14例儿童AML-MRC的临床资料,对其临床特征、实验室检查、预后结果进行回顾性分析。

结果: 14例AML-MRC患儿中位发病年龄11岁(范围1~17岁),男9例,女5例,初诊中位白细胞计数8.3×109/L(范围2.0×109/L~191.0×109/L),中位血红蛋白73 g/L(范围44~86 g/L),中位血小板计数75×109/L(4×109/L~231×109/L)。按照FAB分型,AML-M5占71%(10/14)。14例患儿中,多系发育异常4例,具有骨髓增生异常综合征(MDS)病史2例,携带MDS细胞遗传学改变5例,多系发育异常伴MDS细胞遗传学改变2例,MDS病史伴多系发育异常1例。14例患儿中位随访期10.6个月(范围0.4~54.4个月),2例患儿诊断后即放弃治疗,12例患儿可评估疗效。2年总体生存(OS)率为50%±15%;2年无病生存(DFS)率为33%±13%。7例患儿接受造血干细胞移植(HSCT),且均为单倍体造血干细胞移植,5例无病存活,2例死亡,2年OS率为71%±17%,2年DFS率为43%±19%;5例单纯化疗患儿,1例无病存活,3例死亡,1例失访,2年OS率为40%±30%,2年DFS率为30%±24%。移植组及化疗组生存分析结果差异无统计学意义(P > 0.05)。

结论: 儿童AML-MRC男性患儿多发,FAB分型以AML-M5多见,预后不良。HSCT可有望改善儿童AML-MRC不良预后,但是由于病例数较少,还需增加病例数进一步观察。

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Infant
  • Leukemia, Myeloid, Acute* / diagnosis
  • Leukemia, Myeloid, Acute* / therapy
  • Male
  • Myelodysplastic Syndromes* / diagnosis
  • Myelodysplastic Syndromes* / therapy
  • Prognosis
  • Retrospective Studies