News and Features Collaborating to Improve Outcomes for Older Teens with AML

For many years, clinicians have thought that older teens with acute myeloid leukemia (AML) would tolerate therapies better than the youngest patients.

"Clinicians have assumed that because they were bigger and stronger, they might be able to tolerate treatment better," says Alan Gamis, MD, Chief of the Section of Oncology at Children's Mercy Hospitals and Clinics. Dr. Gamis, along with other leading AML researchers, reviewed outcomes on several Children's Oncology Group (COG) clinical trials for AML to verify this assumption.

"What our study tells us is that those patients are at the highest risk of death due to complications, not the lowest," says Dr. Gamis.

The trials were conducted by the COG and their research included data on AML patients from 200 institutions from 1995 to 2005. Children's Mercy, one of the larger childhood cancer centers in the country, also is one of the larger members of COG. Dr. Gamis chairs COG's national AML committee.

Prior studies have shown that patients aged 16 to 21 years, who might be cared for by either medical or pediatric oncologists, have higher cure rates on the more intensive pediatric AML regimens.  But this also carries greater risk during treatment.  And, AML treatment is considered the most intense of all cancer therapies.  As such, "the norm in pediatrics over the past 10 years has been to keep children in the hospital until their blood counts have recovered.  However, because older patients can tell us how they feel, many clinicians around the world, rather than keep those patients in the hospital, have allowed them to go home before they recovered their blood counts," Dr. Gamis says. 

However, the study, for which lead author Jason Canner presented preliminary results at the American Society of Clinical Oncology Annual Meeting in 2011, "tells us that we must be much more cautious with these patients' care as far as not allowing them to be discharged too early," says Dr. Gamis.  Further, the study identified how to improve survival and cure by improving supportive care.

COG is entering more detailed analyses of patients enrolled in current trials to better identify causes of complications and mortality. "We've also added a couple of additional trials to see if we can prevent those deaths by use of prophylactic antibiotics and antifungals," says Dr. Gamis. The new trials will be offered to patients of all ages. "But we certainly have a heightened interest of what's going to happen for our teens."


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