title: Impact of age on outcome of pediatric acute myeloid leukemia: a report from 2 institutions.
abstract: BACKGROUND
  The prognostic significance of age among pediatric patients with acute myeloid leukemia (AML) was investigated.
  
  
  METHODS
  The authors reviewed the outcome of 424 patients who were <or=21 years of age at the time of diagnosis of AML (excluding acute promyelocytic leukemia) between 1983 and 2002 at St. Jude Children's Research Hospital (n=288) or the M. D. Anderson Cancer Center (n=136). Two treatment eras (1983-1989 and 1990-2002) were examined because of the greater intensity of treatment during the recent era.
  
  
  RESULTS
  After controlling for the effects of cytogenetics, white blood cell (WBC) count, French-American-British (FAB) subtype, and treatment era, they observed that age and treatment era interacted significantly in relation to event-free survival (EFS) (P=.033). Patients 10 years of age or older were at greater risk of an adverse event than younger patients in the recent era (hazard ratio=1.8; 95% confidence interval [CI]: 1.3-2.6; P=.005) but not in the early era. The rate of adverse events (death or recurrence) increased significantly with each year of age in the recent era (4.3%/year; 95% CI: 1.9-6.8%; P=.001) but not in the early era. The rate of death increased significantly with each year of age in both eras (4.4%/year; 95% CI: 2.3-6.5%; P<.001). EFS and survival showed no association with study site, and the effects of age were similar at the 2 sites.
  
  
  CONCLUSIONS
  These results suggest that age is an independent prognostic factor in childhood AML and that children younger than 10 years benefit more than older children from newer intensive therapies.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, and Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, USA. bassem.razzouk@stjude.org
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Razzouk
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
authors.forename: Stanley
authors.initials: S
authors.lastname: Pounds
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Mark
authors.initials: M
authors.lastname: Brandt
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Michael
authors.initials: M
authors.lastname: Rytting
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Sima
authors.initials: S
authors.lastname: Jeha
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D016026:Bone Marrow Transplantation; D002648:Child; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies