Pawińska-Wąsikowska Katarzyna, Czogała Małgorzata, Bukowska-Strakova Karolina, Surman Marta, Rygielska Monika, Książek Teofila, Sadowska Beata, Pac Agnieszka, Skalska-Sadowska Jolanta, Samborska Magdalena, Wachowiak Jacek, Ciebiera Małgorzata, Chaber Radosław, Tomaszewska Renata, Szczepański Tomasz, Zielezińska Karolina, Urasiński Tomasz, Moj-Hackemer Małgorzata, Kałwak Krzysztof, Kozłowska Marta, Irga-Jaworska Ninela, Sikorska-Fic Barbara, Łaguna Paweł, Muszyńska-Rosłan Katarzyna, Krawczuk-Rybak Maryna, Fałkowska Anna, Drabko Katarzyna, Bobeff Katarzyna, Młynarski Wojciech, Chodała-Grzywacz Agnieszka, Karolczyk Grażyna, Mycko Katarzyna, Badowska Wanda, Bartoszewicz Natalia, Styczyński Jan, Machnik Katarzyna, Mizia-Malarz Agnieszka, Balwierz Walentyna, Skoczeń Szymon
Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland.
Department of Pediatric Oncology and Hematology, University Children's Hospital, 30-663 Krakow, Poland.
Cancers (Basel). 2024 Mar 14;16(6):1145. doi: 10.3390/cancers16061145.
The reports of studies that compare the survival of adolescents and young adults with younger children with acute myeloid leukemia (AML) are contradictory.
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).
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, = 0.243). However, relapse-free survival was lower in adolescents compared to younger children (76.5 ± 7.8% vs. 65.7 ± 9.0%, = 0.049), and treatment-related mortality tended to be higher (10.3% vs. 4.4%, = 0.569). In the univariate analysis, high-risk genetics [HR, 2.0 (95% CI 1.1-3.6; = 0.014)] and a leukocyte count at diagnosis above 100,000/μL [HR, 2.4 (95% CI 1.3-4.6; = 0.004)] were found to be unfavorable prognostic factors for survival.
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.
比较急性髓系白血病（AML）青少年及青年与年幼儿童生存率的研究报告相互矛盾。
我们回顾性分析了2015年至2022年在波兰儿科肿瘤中心接受治疗的220例0至18岁的AML患者。评估组包括31例婴儿（1岁以下）、91例年幼儿童（1至9.9岁）、59例大龄儿童（10至14.9岁）和39例青少年（15至18岁）。
青少年的5年总生存率与年幼儿童和大龄儿童相比无显著劣势（74.3±7.6%对80.5±4.4%对77.9±5.1，P = 0.243）。然而，青少年的无复发生存率低于年幼儿童（76.5±7.8%对65.7±9.0%，P = 0.049），且治疗相关死亡率有更高的趋势（10.3%对4.4%，P = 0.569）。在单因素分析中，高危遗传学因素[HR，2.0（95%CI 1.1 - 3.6；P = 0.014）]和诊断时白细胞计数高于100,000/μL[HR，2.4（95%CI 1.3 - 4.6；P = 0.004）]被发现是生存的不利预后因素。
虽然我们未发现15岁以上年龄是总生存的不利因素，但与其他年龄组一样，青少年治疗的最佳方法是根据个体遗传风险调整治疗强度，并在有指征时引入靶向治疗。
