Comparison of childhood myelodysplastic syndrome, AML FAB M6 or M7, CCG 2891: Report from the children's oncology group

Background. Myelodysplastic syndromes (MDS), acute erythroleukemia (FAB M6), and acute megakaryocytic leukemia (FAB M7) have overlapping features. Procedure. Children without Down syndrome or acute promyelocytic leukemia who were newly diagnosed with primary myelodysplastic syndrome or acute myeloid leukemia (AML) M6 or M7 were compared to children with de novo AML M0-M5. All children were entered on the Children's Cancer Group therapeutic research study CCG 2891. Results. The presentation and outcomes of the 132 children diagnosed with MDS (60 children), AML FAB MIS (19 children), or AML FAB M7 (53 children) were similar. Children with AML FAB M7 were diagnosed at a significantly younger age (P=0.001). Children with MDS, M6, or M7 had significantly lower white blood cell (WBC) counts (P=0.001), lower peripheral blast counts (P < 0.001), and an increased frequency of -7/7q- (P=0.003) at presentation. All three groups had significantly inferior overall survival (OS) (P < 0.001) and event free survival (P < 0.001) compared with the 748 children diagnosed with AML FAB M0-M5 when assessed from entry on study. This poor survival was largely attributable to induction death and failure. However, when assessed from successful completion of induction therapy, the 5-year OS (P=0.090)(49.1 vs. 56.9%) and disease-free survival (DFS) (P=0.113)(38.0 vs. 46.3%) therapy were not significantly different from other children with AML. Conclusions. Childhood AML FAB M6 and AML M7 resemble MDS in presentation, poor induction success rates, and outcomes.