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Review
. 2015 Mar;29(2):101-25.
doi: 10.1016/j.blre.2014.09.013. Epub 2014 Sep 30.

Global characteristics of childhood acute promyelocytic leukemia

L Zhang  1 , A Samad  2 , M S Pombo-de-Oliveira  3 , G Scelo  4 , M T Smith  5 , J Feusner  6 , J L Wiemels  7 , C Metayer  8
Affiliations
Review

Global characteristics of childhood acute promyelocytic leukemia

L Zhang et al. Blood Rev. 2015 Mar.

Abstract

Acute promyelocytic leukemia (APL) comprises approximately 5-10% of childhood acute myeloid leukemia (AML) cases in the US. While variation in this percentage among other populations was noted previously, global patterns of childhood APL have not been thoroughly characterized. In this comprehensive review of childhood APL, we examined its geographic pattern and the potential contribution of environmental factors to observed variation. In 142 studies (spanning >60 countries) identified, variation was apparent-de novo APL represented from 2% (Switzerland) to >50% (Nicaragua) of childhood AML in different geographic regions. Because a limited number of previous studies addressed specific environmental exposures that potentially underlie childhood APL development, we gathered 28 childhood cases of therapy-related APL, which exemplified associations between prior exposures to chemotherapeutic drugs/radiation and APL diagnosis. Future population-based studies examining childhood APL patterns and the potential association with specific environmental exposures and other risk factors are needed.

Keywords: AML-M3; Acute promyelocytic leukemia; Environmental exposure; Pediatric leukemia; Risk factors; Therapy-related leukemia.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr. Smith has received consulting and expert testimony fees from lawyers representing both plaintiffs and defendants in cases involving claims related to exposure to chemicals and leukemia. The remaining authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1. Study selection process
This flow diagram depicts the logic of the study selection process, the results of which are included in this review. In total, 228 studies were included.
Figure 2
Figure 2. Global map of de novo childhood APL as a percentage of AML
The percentage of childhood AML cases comprised of APL cases was calculated for each country by averaging all the studies collected for that country. *Study was conducted in region formerly known as Yugoslavia, which includes present day nations of Serbia, Montenegro, Slovenia, Croatia, Bosnia and Herzegovina and the Republic of Macedonia. **One study contained data from patients in both Australia and New Zealand.
Figure 3
Figure 3. Gender ratios for APL in children
To examine gender, the de novo childhood APL studies were divided into two groups: APL/AML Studies and APL Only Studies. “APL/AML” contained data from studies previously reported in Table 2. “APL Only Studies” contained no information regarding the proportion of APL among AML cases and are represented here for the first time.
Figure 4
Figure 4. a–b Distribution of data from therapy-related APL studies in Children
Figure 4a depicts age (in years) at t-APL diagnosis for n=28 cases. Figure 4b depicts time to APL (latency) for n=24 cases.
Figure 4
Figure 4. a–b Distribution of data from therapy-related APL studies in Children
Figure 4a depicts age (in years) at t-APL diagnosis for n=28 cases. Figure 4b depicts time to APL (latency) for n=24 cases.
See this image and copyright information in PMC

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