Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries.
BACKGROUND
Studies on adolescents and young adults with acute lymphoblastic leukemia suggest better results when using pediatric protocols for adult patients, while corresponding data for acute myeloid leukemia (AML) are limited.


METHODS
We investigated disease characteristics and outcome for de novo AML patients 10-30 years old treated in pediatric or adult departments. We included 166 patients 10-18 years of age with AML treated according to the pediatric NOPHO-protocols (1993-2009) compared with 253 patients aged 15-30 years treated in hematology departments (1996-2009) in the Nordic countries.


RESULTS
The incidence of AML was 4.9/million/year for the age group 10-14 years, 6.5 for 15-18 years, and 6.9 for 19-30 years. Acute promyelocytic leukemia (APL) was more frequent in adults and in females of all ages. Pediatric patients with APL had similar overall survival as pediatric patients without APL. Overall survival at 5 years was 60% (52-68%) for pediatric patients compared to 65% (58-70%) for adult patients. Cytogenetics and presenting white blood cell count were the only independent prognostic factors for overall survival. Age was not an independent prognostic factor.


CONCLUSIONS
No difference was found in outcome for AML patients age 10-30 years treated according to pediatric as compared to adult protocols.
Department of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Lovisa
L
Wennström
Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
Pernille Wendtland
PW
Edslev
Department of Pediatrics, Queen Silvia Children's Hospital, Göteborg, Sweden.
Jonas
J
Abrahamsson
Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
Jan Maxwell
JM
Nørgaard
Department of Hematology, University Hospital, Rikshospitalet, Oslo, Norway.
Yngvar
Y
Fløisand
Department of Medical Biosciences, Umeå University Hospital, Umeå, Sweden.
Erik
E
Forestier
Children Cancer Research Unit, Karolinska Hospital, Stockholm, Sweden.
Göran
G
Gustafsson
Department of Pediatrics, University Hospital, Lund, Sweden.
Jesper
J
Heldrup
Department of Pediatrics, University of Helsinki, Helsinki, Finland.
Liisa
L
Hovi
Department of Pediatrics, University of Helsinki, Helsinki, Finland.
Kirsi
K
Jahnukainen
Department of Pediatrics, Landspitalinn, Reykjavik, Iceland.
Olafur Gisli
OG
Jonsson
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Birgitte
B
Lausen
Department of Pediatrics, University of Uppsala, Uppsala, Sweden.
Josefine
J
Palle
Department of Pediatrics, University Hospital, Rikshospitalet, Oslo, Norway.
Bernward
B
Zeller
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
Erik
E
Holmberg
Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
Gunnar
G
Juliusson
Department of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Dick
D
Stockelberg
Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
Henrik
H
Hasle
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006405:Hematology; D006748:Hospital Departments; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D010372:Pediatrics; D011379:Prognosis; D012537:Scandinavian and Nordic Countries; D055815:Young Adult
acute myeloid leukemia; adolescents; age; outcome; young adults