Is the outcome of childhood acute myeloid leukemia with t(8;21) inferior in Saudi Arabia? A multicenter SAPHOS leukemia group study
Wasil Jastaniah1, Abdulrahman Alsultan2, Saad Al Daama3, Walid Ballourah4, Mohammad Bayoumy5, Faisal Al-Anzi6, Omar Al Shareef7, Mohammed Burhan Abrar8, Reem Al Sudairy9, Ibrahim Al Ghemlas10
1 Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah; Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
2 Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 King Fahad Specialist Hospital, Dammam, Saudi Arabia
4 King Fahad Medical City, Riyadh, Saudi Arabia
5 King Faisal Specialist Hospital & Research Center Jeddah, Jeddah, Saudi Arabia
6 PrinceFaisalBin Bandar Cancer Center, Qaseem, Saudi Arabia
7 Prince Sultan Military Medical City, Saudi Arabia
8 Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
9 Department of Pediatric Hematology/Oncology, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Saudi Arabia
10 Faculty of Medicine, Alfaisal University; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, PO Box 9515 Box 9515, Jeddah 21423
Source of Support: None, Conflict of Interest: None
Background: Despite the confirmed favorable prognosis of childhood t(8;21) acute myeloid leukemia (AML), recent reports suggest heterogeneity in survival outcomes in this subtype of AML may be influenced by ethnicity. Therefore, we aimed to assess the outcome of childhood t(8;21) AML in an Arab population to evaluate if survival outcomes were inferior and determine the predictive relevance of additional cytogenetic abnormalities.
Methods: This multicenter retrospective study analyzed 175 de novo AML children of 14 years of age or younger consecutively diagnosed between January 2005 and December 2012. Survival outcomes were analyzed and patients with t(8;21) were stratified on the basis of karyotype into sole and additional cytogenetic groups.
Results: A total of 33 (18.9%) patients had t(8;21) AML. Complete remission (CR) was achieved in 31 (93.9%) patients. The 5-year overall survival, event-free survival, cumulative incidence of relapse (CIR), and remission death rates were 59.9 ± 9.2, 45.6 ± 9.1, 36.4, and 9.1%, respectively. Despite the administration of hematopoietic stem-cell-transplant salvage therapy in first relapse, five out of 11 (45.5%) relapsed patients died of disease. Subanalysis of sole vs. additional cytogenetic abnormalities revealed no significant difference in outcome.
Conclusion: In the present study, childhood t(8;21) AML was associated with inferior survival and resistance to salvage therapy compared to reports from international groups. The inferior outcomes were unrelated to additional cytogenetic abnormalities. Further detailed genetic studies are warranted to unmask the biological and clinical differences between racial/ethnic groups. Given the high CR rate of childhood t(8;21) AML, further modification of postremission therapy to improve the CIR rate is needed.