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.

Expert review and references

  • American Cancer Society. Childhood Leukemia Early Detection, Diagnosis and Types. 2016: https://www.cancer.org.
  • Acute myeloid - AML - childhood. American Society of Clinical Oncology (ASCO). Cancer.Net. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2011.
  • Arceci RJ and Meshinchi S . Acute myeloid leukemia and myelodysplastic syndromes. Pizzo PA & Poplack DG (eds.). Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016: 20: 498-544.
  • Montoya, L . Myeloid diseases. Baggott C, Fochtman D, Foley GV & Patterson Kelly, K (eds.). Nursing Care of Children and Adolsecents with Cancer and Blood Disorders. 4th ed. APHON; 2011: 26: pp.967-986.
  • National Cancer Institute. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®) Patient Version. 2018.
  • Weinblatt ME. Medscape Reference: Pediatric Acute Myelocytic Leukemia. 2017: http://emedicine.medscape.com/.

Risk groups for childhood AML

Prognostic factors for childhood acute myelogenous leukemia (AML) can determine level of risk and predict outcome. Learn about levels of risk for childhood AML.

Survival statistics for childhood AML

Survival statistics are reported based on groups of children with acute myelogenous leukemia (AML). Learn about survival statistics for childhood ALL.