title: Prognostic factors of childhood and adolescent acute myeloid leukemia (AML) survival: evidence from four decades of US population data.
abstract: Growing insight into prognosis of pediatric acute myeloid leukemia (AML) survival has led to improved outcome over time and could be further enhanced through investigation using a large number of patients. To characterize the extent of the association of pediatric AML survival with its identified prognostic factors, we analyzed the United States population-based Surveillance Epidemiology and End Results (SEER) large dataset of 3442 pediatric AML patients diagnosed and followed between 1973 and 2011 using a Cox proportional hazards model stratified by year of diagnosis. Patients diagnosed between 10 and 19 years of age were at a higher risk of death compared to those diagnosed before age 10 (adjusted hazard ratio (aHR): 1.30, 95% confidence interval (CI): 1.17-1.44). African Americans (1.27, 1.09-1.48) and Hispanics (1.15, 1.00-1.32) had an elevated risk of mortality than Caucasians. Compared to the subtype acute promyelocytic leukemia, AML with minimal differentiation (2.44, 1.78-3.35); acute erythroid leukemia (2.34, 1.60-3.40); AML without maturation (1.87, 1.35-2.59); and most other AML subtypes had a higher risk of mortality, whereas AML with inv(16) had a substantially lower risk. Age at diagnosis, race-ethnicity, AML subtype, county level poverty and geographic region appeared as significant prognostic factors of pediatric AML survival in the US. Contrary to previous findings, the subtypes of AML with t(9;11)(p22;q23)MLLT3-MLL, AML without maturation and acute myelomonocytic leukemia emerged to be indicative of poor outcome.
authors.affiliation: Nemours Biomedical Research, A I duPont Hospital for Children, Wilmington, DE 19803, United States; Department of Applied Economics and Statistics, University of Delaware, Newark, DE 19716, United States. Electronic address: jhossain@nemours.org.
authors.forename: Md Jobayer
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: Nemours Biomedical Research, A I duPont Hospital for Children, Wilmington, DE 19803, United States.
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Hematology/Oncology, A I duPont Hospital for Children, Wilmington, DE 19803, United States.
authors.forename: Emi H
authors.initials: EH
authors.lastname: Caywood
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Acute myeloid leukemia; Heterogeneous; Prognostic factors; SEER; Stratified Cox-proportional hazard model