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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1714-1720
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Relationships between age at diagnosis, clinical features, and
outcome of therapy in children treated in the Medical Research Council
AML 10 and 12 trials for acute myeloid leukemia
David K. H. Webb,
Georgina Harrison,
Richard F. Stevens,
Brenda G. Gibson,
Ian M. Hann, and
Keith Wheatley for the MRC
Childhood Leukaemia Working Party
From the Great Ormond Street Hospital for Children,
London, United Kingdom; Clinical Trial Service Unit, Oxford, United
Kingdom; Royal Manchester Children's Hospital, Manchester, United
Kingdom, Royal Hospital for Sick Children, Glasgow, United Kingdom; and
the University of Birmingham Clinical Trials Unit, Birmingham, United
Kingdom.
Between May 1988 and June 2000, 698 children were treated in the
Medical Research Council acute myeloid leukemia 10 and 12 trials. The
presenting features and outcomes of therapy in these children were
compared by age. Although there was no single cutoff in age, younger
children were more likely to have intermediate risk and less likely to
have favorable cytogenetics (P < .001), and they had a
higher incidence of translocations involving chromosome 11q23
(P < .001). The distribution of French-American-British (FAB) types also varied with age; FAB types M5
(P < .001) and M7 (P < .001) were more
common in early childhood, whereas older children were more likely to
have FAB types M0 (P = .03), M1 (P = .04),
M2 (P = .005), and M3 (P < .001).
Involvement of the central nervous system at diagnosis was also more
common in the youngest children (P = .01). Younger
children had more severe diarrhea (P = .002), whereas
older children had worse nausea and vomiting (P = .01)
after chemotherapy. When adjusted for other important factors, complete
remission rates were similar (P = .5) and although there
was less resistant disease in younger children
(P = .003), this was partially balanced by a slight
increase in deaths during induction therapy in younger patients
(P = .06). On multivariate analysis overall survival
(P = .02), event-free survival (P = .02),
and disease-free survival were better (P = .06) in
younger children due to a lower relapse rate (P = .02)
especially in the bone marrow (P = .02).
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