Increased survival disparities among children and adolescents & young adults with acute myeloid leukemia: A Dutch population-based study

Abstract

For many cancers, adolescents and young adults (AYAs) have a poorer prognosis than pediatric patients. Our study evaluates survival outcomes of children (0-17 years) and AYAs (18-39 years) diagnosed with acute myeloid leukemia (AML) in the Netherlands between 1990 and 2015 (N = 2058) utilizing the population-based Netherlands Cancer Registry, which includes information on therapy and site of primary treatment. Five- and 10-year relative (disease-specific) survival were estimated for all patients, children and AYAs. Multivariable analyses were performed using generalized linear models (excess mortality) and logistic regression (early mortality). AYAs with AML had a substantially lower 5- and 10-year relative survival than children (5-year: 43% vs 58%; 10-year: 37% vs 51%). The gap in 5-year relative survival was largest (nearly 20 percent-points) in 2010 to 2015, despite survival improvements over time across all ages. The multivariable-adjusted excess risk of dying was 60% higher in AYAs (95% CI: 37%-86%). Early mortality (death within 30 days of diagnosis) declined over time, and did not differ between children and AYAs. In conclusion, AYAs diagnosed with AML in the Netherlands had a worse prognosis than pediatric patients. The survival gap seemed most pronounced in recent years, suggesting that improvements in care resulting in better outcome for children have not led to equal benefits for AYAs.

Keywords: acute myeloid leukemia; adolescents and young adults; children; early mortality; relative survival.

FIGURE 1

Five‐year relative survival of children (0‐17 years) and AYAs (18‐39 years) diagnosed with AML (excl. APL and ML‐DS, A) and APL (B) in the Netherlands between 1990 and 2015, overall and by diagnostic period. The error bars depict 95% CI of the survival estimates. ^*N at risk <10. AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; AYAs, adolescents and young adults; ML‐DS, myeloid leukemia associated with Down syndrome

FIGURE 2

Age‐specific 5‐year relative survival of children and AYAs (0‐39 years) diagnosed with AML (excl. APL and ML‐DS) in the Netherlands between 1990 and 2015, overall and by diagnostic period. For each age category, the number of patients at risk in the entire period 1990 to 2015 is displayed. AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; AYAs, adolescents and young adults; ML‐DS, myeloid leukemia associated with Down syndrome

FIGURE 3

Early mortality (death within 30 days of diagnosis) in children (0‐17 years) and AYAs (18‐39 years) diagnosed with AML (excl. APL and ML‐DS) in the Netherlands between 1990 and 2015, overall and by diagnostic period. AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; AYAs, adolescents and young adults; ML‐DS, myeloid leukemia associated with Down syndrome

FIGURE 4

Age‐specific early mortality (death within 30 days of diagnosis) in children and AYAs (0‐39 years) diagnosed with AML (excl. APL and ML‐DS) in the Netherlands between 1990 and 2015. For each age category, the number of patients at risk in the entire period 1990 to 2015 is displayed. AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; AYAs, adolescents and young adults; ML‐DS, myeloid leukemia associated with Down syndrome