02Nov 2018


  • Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan.
  • National University of Medical Sciences, Rawalpindi, Pakistan.
  • Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Objective: To document the demographics and treatment outcome of Paediatric Acute Myeloid Leukaemia (AML) at a tertiary care facility of Pakistan. Methods: The prospective descriptive study conducted at the Paediatric Oncology department, Combined Military Hospital (CMH) Rawalpindi, Pakistan. All newly registered cases of AML under eighteen years of age from 1st January 2012 onwards who completed their treatment before 30th September 2018 were included. Results: Data of 187 cases of De novo AML, including 117 (62.6 %) males and 70 (37.4 %) females was analysed. The mean age was 6.1 ? 3.53 years. The most common presenting features were pallor 156 (83.4%), fever 143 (76.5%) & bruising/bleeding 95 (50.8 %). Sixty-six (35.3 %) patients had WBC >50x109/L at presentation. The most common FAB subtype was M-2 in 85 (45.5 %), followed by M-4 in 25 (13.4 %) cases. The overall treatment related mortality (TRM) was 55/187 (29.4%). The major causes of TRM were neutropenic sepsis and bleeding. Sixty patients had refractory or relapsed disease and 53 (88.3%) of them also died. Total 121 patients completed full treatment. OS and DFS of these 121 patients were 65.3 % and 59.5% respectively. Conclusions: This is the largest study of Paediatric AML from Pakistan. High TRM, primarily during induction chemotherapy and relapsed/refractory disease are the major causes of treatment failure. AML-M2 has the best survival rates. Malnutrition, high WBC counts at presentation and unfavourable cytogenetics have decreased OS and DFS rates. Use of Etoposide during induction chemotherapy does not give any survival advantage.

  1. Taga T, Tomizawa D, Takahashi H, Adachi S. Acute myeloid leukemia in children: Current status and future directions. Pediatr Int. 2016;58(2):71-80.
  2. Wennstrom L, Edslev PW, Abrahamsson J, Norgaard JM, Floisand Y, Forestier E, et al. Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries. Pediatr Blood Cancer. 2016;63(1):83-92.
  3. Creutzig U, van den Heuvel-Eibrink MM, Gibson B, Dworzak MN, Adachi S, de Bont E, et al. Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel. Blood. 2012;120(16):3187-205.
  4. Gupta S, Bonilla M, Valverde P, Fu L, Howard SC, Ribeiro RC, et al. Treatment-related mortality in children with acute myeloid leukaemia in Central America: incidence, timing and predictors. Eur J Cancer. 2012;48(9):1363-9.
  5. Fadoo Z, Mushtaq N, Alvi S, Ali M. Acute myeloid leukaemia in children: experience at a tertiary care facility of Pakistan. JPMA The Journal of the Pakistan Medical Association. 2012;62(2):125-8.
  6. Asim M, Zaidi A, Ghafoor T, Qureshi Y. Death analysis of childhood acute lymphoblastic leukaemia; experience at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. JPMA The Journal of the Pakistan Medical Association. 2011;61(7):666-70.
  7. Ravandi F. Primary refractory acute myeloid leukaemia - in search of better definitions and therapies. Br J Haematol. 2011;155(4):413-9.
  8. Lee JY, Chung H, Cho H, Jang JE, Kim Y, Kim SJ, et al. Clinical characteristics and treatment outcomes of isolated myeloid sarcoma without bone marrow involvement: a single-institution experience. Blood research. 2017;52(3):184-92.
  9. Taga T, Imamura T, Nakashima K, Maeda N, Watanabe A, Miyajima Y, et al. Clinical characteristics of pediatric patients with myeloid sarcoma without bone marrow involvement in Japan. International journal of hematology. 2018.
  10. Ghafoor T, Zaidi A, Al Nassir I. Granulocytic sarcoma of the small intestine: an unusual presentation of acute myelogenous leukaemia. JPMA The Journal of the Pakistan Medical Association. 2010;60(2):133-5.
  11. Mitkowski D, Gil L. Isolated myeloid sarcoma as the first manifestation of acute myeloid leukemia: a case study. Clinical case reports. 2017;5(11):1802-6.
  12. Gibson BE, Webb DK, Howman AJ, De Graaf SS, Harrison CJ, Wheatley K. Results of a randomized trial in children with Acute Myeloid Leukaemia: medical research council AML12 trial. Br J Haematol. 2011;155(3):366-76.
  13. Jastaniah W, Al Ghemlas I, Al Daama S, Ballourah W, Bayoumy M, Al-Anzi F, et al. Clinical characteristics and outcome of childhood de novo acute myeloid leukemia in Saudi Arabia: A multicenter SAPHOS leukemia group study. Leukemia research. 2016; 49:66-72.
  14. Bashasha S, Kordofani A, Osman I, Musa O, Altayb H. Prevalence of the different FAB sub type of Acute Myeloid Leukemia related to hematological parameters in Sudanese. J Hematol Blood Disord. 2017;3(1):102.
  15. De Kouchkovsky I, Abdul-Hay M. \'Acute myeloid leukemia: a comprehensive review and 2016 update\'. Blood cancer journal. 2016;6(7): e441.
  16. Inaba H, Surprise HC, Pounds S, Cao X, Howard SC, Ringwald-Smith K, et al. Effect of body mass index on the outcome of children with acute myeloid leukemia. Cancer. 2012;118(23):5989-96.
  17. Miyawaki S, Tanimoto M, Kobayashi T, Minami S, Tamura J, Omoto E, et al. [Effect of etoposide added to individualized induction therapy of adult acute myeloid leukemia--the JALSG-AML-92 Study. Japan Adult Leukemia Study Group]. Gan to kagaku ryoho Cancer & chemotherapy. 2000;27(8):1160-7.
  18. Creutzig U, Zimmermann M, Reinhardt D, Dworzak M, Stary J, Lehrnbecher T. Early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analysis of the multicenter clinical trials AML-BFM 93 and AML-BFM 98. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2004;22(21):4384-93.
  19. Rubnitz JE, Lensing S, Zhou Y, Sandlund JT, Razzouk BI, Ribeiro RC, et al. Death during induction therapy and first remission of acute leukemia in childhood: the St. Jude experience. Cancer. 2004;101(7):1677-84.
  20. Molgaard-Hansen L, Mottonen M, Glosli H, Jonmundsson GK, Abrahamsson J, Hasle H. Early and treatment-related deaths in childhood acute myeloid leukaemia in the Nordic countries: 1984-2003. Br J Haematol. 2010;151(5):447-59.
  21. Vedi A, Mitchell R, Shanmuganathan S, Oswald C, Marshall GM, Trahair T, et al. Increased Survival for Children With Acute Myeloid Leukemia Results From Improved Postrelapse Treatment. Journal of pediatric hematology/oncology. 2018;40(7):541-7.
  22. Klusmann JH, Reinhardt D, Zimmermann M, Kremens B, Vormoor J, Dworzak M, et al. The role of matched sibling donor allogeneic stem cell transplantation in pediatric high-risk acute myeloid leukemia: results from the AML-BFM 98 study. Haematologica. 2012;97(1):21-9.

[Tariq Ghafoor, Imtenan Sharif, Tanveer Ashraf, Shakeel Ahmed and Farrah Bashir. (2018); PAEDIATRIC ACUTE MYELOID LEUKAEMIA; CLINICAL CHARACTERISTICS AND TREATMENT OUTCOME; EXPERIENCE FROM A DEVELOPING COUNTRY. Int. J. of Adv. Res. 6 (11). 113-122] (ISSN 2320-5407). www.journalijar.com

Dr.Tariq Ghafoor
Paediatric Oncologist and Bone Marrow Transplant Specialist Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan, 46000 Tel +923008519006


Article DOI: 10.21474/IJAR01/7977       DOI URL: http://dx.doi.org/10.21474/IJAR01/7977

Share this article