Diagnosis and Treatment of Pediatric Acute Myeloid Leukemia
10.15264/cpho.2015.22.1.8
- Author:
Jae Wook LEE
1
;
Bin CHO
Author Information
1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. chobinkr@catholic.ac.kr
- Publication Type:Review
- Keywords:
Acute myeloid leukemia;
Children;
Genetic abnormalities;
Chemotherapy;
Hematopoietic cell transplantation
- MeSH:
Adolescent;
Child;
Classification;
Complement System Proteins;
Consensus;
Core Binding Factors;
Diagnosis;
Disease-Free Survival;
Down Syndrome;
Drug Therapy;
Fanconi Anemia;
Humans;
Korea;
Leukemia;
Leukemia, Myeloid, Acute;
Sarcoma, Myeloid;
World Health Organization
- From:Clinical Pediatric Hematology-Oncology
2015;22(1):8-14
- CountryRepublic of Korea
- Language:English
-
Abstract:
Acute myeloid leukemia (AML) is a heterogeneous malignancy that comprises 25-30% of pediatric leukemias in Korea. Several inherited diseases, such as Down syndrome and Fanconi anemia, predispose towards AML leukemogenesis. Subgrouping of AML is a key diagnostic step, previously done with the French-American-British (FAB) classification and recently complemented by that of the World Health Organization (WHO). An important feature of AML is the possibility of chloroma at diagnosis, which, if detected, requires follow-up evaluation to determine treatment response. Numerous genetic abnormalities with prognostic relevance have recently been found, the most important of which include those of the core-binding factor (CBF) leukemias, and FLT3-ITD mutation. These genetic abnormalities, combined with patient response to initial treatment, allow for a scheme of risk stratification, and the current consensus is to treat low risk patients with chemotherapy only, whereas high risk patients may receive allogeneic transplant in first remission, although the benefits of transplant remain inconclusive. Overall, the outcome of children and adolescents with AML has improved significantly so that many clinical trials now report event-free survival of around 60%. However, much of this improvement stems from better supportive care and transplant methods, and the genetics-based diagnostic advances in AML have yet to result in enhanced treatment. New therapeutics, including possibly targeted therapy, are necessary to further improve the outcome of pediatric AML.
