Treatment Outcomes of Adolescents Compared to Younger Pediatric Patients with Acute Myeloid Leukemia: Do They Need a Special Approach?

Simple Summary The aim of this study was to retrospectively analyze the characteristics and treatment outcomes of adolescents with AML compared to children and infants treated, according to the two consecutive BFM protocols. It showed that overall survival did not differ significantly between adolescents and children aged 1 to 15 years. However, relapse-free survival was shorter in adolescents compared to younger children, and treatment-related mortality tended to be higher. High-risk genetics and a leukocyte count above 100,000/mu L at diagnosis, rather than age above 15 years, proved to be unfavorable prognostic factors for the treatment outcome.Abstract Background: The reports of studies that compare the survival of adolescents and young adults with younger children with acute myeloid leukemia (AML) are contradictory. Patients and Methods: We retrospectively analyzed 220 AML patients aged 0-18 years treated in pediatric oncologic centers in Poland from 2015 to 2022. The evaluated group included 31 infants (below 1 year), 91 younger children (1-9.9 years), 59 older children (10-14.9 years), and 39 adolescents (15-18 years). Results: A 5-year overall survival for adolescents was not significantly inferior compared to younger and older children (74.3 +/- 7.6% vs. 80.5 +/- 4.4% vs. 77.9 +/- 5.1, p = 0.243). However, relapse-free survival was lower in adolescents compared to younger children (76.5 +/- 7.8% vs. 65.7 +/- 9.0%, p = 0.049), and treatment-related mortality tended to be higher (10.3% vs. 4.4%, p = 0.569). In the univariate analysis, high-risk genetics [HR, 2.0 (95% CI 1.1-3.6; p = 0.014)] and a leukocyte count at diagnosis above 100,000/mu L [HR, 2.4 (95% CI 1.3-4.6; p = 0.004)] were found to be unfavorable prognostic factors for survival. Conclusions: Although we have not found that age over 15 years is an unfavorable factor for overall survival, the optimal approach to therapy in adolescents, as in other age groups, is to adjust the intensity of therapy to individual genetic risk and introduce targeted therapies when indicated.