Prognosis and survival for childhood AML
The following are prognostic factors for childhood acute myelogenous leukemia (AML).
Age
Children who are diagnosed with AML before they are 2 years old have a slightly better prognosis than older children, especially teens.
White blood cell (WBC) count at diagnosis
The white blood cell (WBC) count at diagnosis is also called the initial WBC count. Children with WBC counts less than 100,000 cells/mm3 at diagnosis may have a slightly better prognosis than children with higher WBC counts.
Chromosome and gene abnormalities
Chromosome and gene abnormalities in the leukemia cells that are linked with a favourable prognosis include:
- t(8;21)(q22;q22); RUNX1-RUNX1T1
- inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB-MYH11
- t(15;17)(q22;q12); PML-RARA
- t(11,19); KMT2A-ELL
- NPM1 gene mutation
- CEBPA gene mutation
Chromosome and gene abnormalities in the leukemia cells that are linked with an unfavourable prognosis include:
- monosomy-7
- monosomy-5 and del(5q)
- inv(3)(q21;q26.2) or t(3;3)(q21;q26.2); RPN1-EVI1
- t(4;11); FRYL-MLL
- t(6;11)(q27;q23); AF10-MLL
- t(6;9); DEK-NUP214
- t(7;12); MNX1-ETV6
- t(5;11); NUP98-NSD1
- inv(16)(p13.3;q24.3); CBFA2T3-GLIS2
- FLT3/ITD gene mutation
- HAR gene mutation
- WT1 gene mutation
Down syndrome
Children with Down syndrome who are under 4 years old and diagnosed with AML tend to have a better prognosis.
Subtype of AML
Some subtypes of AML have a better prognosis than others. The M3 subtype is a unique subtype of AML called acute promyelocytic leukemia (APL) and it has a better prognosis than the rest. The M0 and M7 subtypes tend to have a poorer prognosis.
Myelodysplastic syndrome or secondary AML
Children who have AML as a result of myelodysplastic syndrome or treatment for another cancer (called secondary AML) have a less favourable prognosis.
Leukemia cells in the central nervous system (CNS)
Children with leukemia that has spread to the brain and spinal cord (called the central nervous system, or CNS) at diagnosis have a higher risk of isolated CNS recurrence (relapse). This means that the leukemia comes back only in the CNS.
Response to treatment
Children whose leukemia responds quickly to treatment (children who go into remission after only one cycle of chemotherapy) have a better prognosis than children whose leukemia does not respond quickly or who need more than one cycle of chemotherapy to go into remission.
Disease that is still present after treatment but can only be found using more sensitive tests is called minimal residual disease (MRD). Children with MRD at the end of induction chemotherapy have a poorer prognosis then children with no MRD after induction chemotherapy.
Body weight
Children who are underweight or overweight tend to have a poorer prognosis than children with a normal weight.