# Treatment Outcomes and Factors Affecting Survival in Pediatric Acute Myeloid Leukemia

## TL;DR

This study analyzed survival outcomes in pediatric AML patients in Turkey, finding better survival rates for AML-M3 subtype and identifying factors like age and blood counts that affect survival.

## Contribution

The study provides insights into survival factors in pediatric AML patients in Turkey and highlights the need for personalized treatments for high-risk subgroups.

## Key findings

- AML-M3 patients had significantly better 5-year survival rates (94%) compared to non-AML-M3 patients (43%).
- Younger patients (<2 years) and older patients (>14 years) had higher mortality rates.
- Leukocyte counts ≥50×10⁹/L and low hemoglobin levels were associated with lower survival rates.

## Abstract

This study examined the clinical, genetic, and treatment response characteristics of pediatric patients with acute myeloid leukemia (AML) treated according to the 2004 and 2012 AML-BFM protocols. This study aimed to determine survival outcomes and the factors affecting them, and to compare the results with international data. This study retrospectively evaluated pediatric AML patients aged < 18 years in eastern Turkey between January 2010 and December 2023. The AML-BFM 2004 and AML-BFM 2012 protocols were applied to the patients. The risk groups of the patients were determined based on their responses to chemotherapy and genetic results. Survival analyses were conducted using the Kaplan–Meier method. Univariate and multivariate Cox regression analyses were used. Forty-nine patients were included in this study. The median age at diagnosis was 12 years, and 51% of the patients were female. The most common morphological subtype was AML M3, accounting for 32.7% of cases. Complete remission was achieved in 81.6% of patients after induction therapy, whereas 12.2% died during this phase. Relapse occurred in 26.5% of patients. Overall, 38.8% of patients died. AML-M3 patients had a median overall survival (OS) of 113 months, which was better than that of non-AML-M3 patients. Five-year survival rates were 94% for AML-M3 patients and 43% for non-AML-M3 patients. Lower survival rates were observed in patients with leukocyte counts ≥ 50 × 10⁹/L, low hemoglobin levels, non-AML-M3, and poor induction response. Mortality was higher in patients younger than two years and > 14 years. There were no significant differences in mortality, survival, or relapse rates between the AML-BFM 2004 and AML-BFM 2012 protocols (p > 0.005). No significant association was observed between mortality and leukapheresis. Further research should focus on developing personalized treatments for high-risk patients and those without non-AML-M3, given their poorer survival rates than those of AML-M3 patients.