Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2022; 43(04): 342-348
DOI: 10.1055/s-0042-1754370
Review Article

Pediatric Acute Myeloid Leukemia in India: A Systematic Review

Shyam Srinivasan 
1   Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Venkata Rama Mohan Gollamudi
1   Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Nidhi Dhariwal
1   Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Lower-middle-income countries face unique problems in the management of pediatric acute myeloid leukemia (AML) due to which the outcomes have not kept pace with developed nations. In India, data on childhood AML is sparsely available, thus making a true assessment of disease trends difficult. The current systematic review was undertaken to assess the outcomes of childhood AML from published literature from India over a period of 10 years (2011–2021).

Materials and Methods A systematic search of MEDLINE, Google Scholar, and SCOPUS was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement from January 1, 2011 to December 31, 2021. In addition, International Society of Pediatric Oncology (SIOP) conference abstracts were also screened for relevant studies on AML from India. This study was registered in PROSPERO (ID42021273218).

Results A total of 1,210 patients from 19 studies were included. Standard 3 + 7 and MRC AML based regimens were commonly adopted regimens for induction. Remission rates varied between 56 and 95%. Overall treatment-related mortality across studies was 23.2% (95% confidence interval [CI]: 10.3–35.9%). The mean incidence of treatment abandonment was 19.3% ( 95% CI: 10.9–27.5%). Event-free survival and overall survival were in the range of 28 to 55% and 15 to 66%, respectively. Hematopoietic stem cell transplantation was performed only on a small subset of patients.

Conclusion  Outcomes of pediatric AML in India continue to be suboptimal with high treatment abandonment and toxic deaths. Ensuring uniform access to therapy and supportive care along with a robust social support system would improve outcomes of childhood AML in India.

Keywords

acute myeloid leukemia - India - lower-middle-income countries - abandonment

Other Information

Protocol registration: PROSPERO (ID42021273218).


Competing Interests

The authors do not have any competing interests to declare.

All data that have been collected for the purpose of this systematic review have been from published literature and are available in public domains.


Authors' Contributions

Shyam Srinivasan was involved in conceptualization, designing, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, manuscript preparation, manuscript editing, and manuscript review.


Venkata Rama Mohan Gollamudi contributed to literature search and manuscript preparation.


Nidhi Dhariwal did literature search, data acquisition, and data analysis.


Supplementary Material



Publication History

Article published online:
01 September 2022

© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014; 64 (02) 83-103
    CrossrefPubMedGoogle Scholar
  • 2 Chen J, Glasser CL. New and emerging targeted therapies for pediatric acute myeloid leukemia (AML). Children (Basel) 2020; 7 (02) 1-15
    Google Scholar
  • 3 Van Weelderen RE, Klein K, Natawidjaja MD, De Vries R, Kaspers GJ. Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature. Expert Rev Anticancer Ther 2021; 21 (07) 765-780 [Internet]
    CrossrefPubMedGoogle Scholar
  • 4 Arora RS, Arora B. Acute leukemia in children: a review of the current Indian data. South Asian J Cancer 2016; 5 (03) 155-160
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: an Indian perspective. Pediatr Hematol Oncol 2011; 28 (04) 257-268
    CrossrefPubMedGoogle Scholar
  • 6 Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. [Internet]. [cited 2022 May 14]. Accessed July 12, 2022 from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
    Google Scholar
  • 7 National Heart, Lung, and Blood Institute. Quality assessment tool for observational cohort and cross-sectional studies [cited 2022 January 5]. Accessed July 12, 2022 from: https://www.nhlbi.nih.gov/healthtopics/study-quality-assessment-tools.
    Google Scholar
  • 8 Gupta N, Seth T, Mishra P. et al. Treatment of acute myeloid leukemia in children: experience from a tertiary care hematology centre in India. Indian J Pediatr 2011; 78 (10) 1211-1215
    CrossrefPubMedGoogle Scholar
  • 9 Yadav SP, Ramzan M, Lall M, Sachdeva A. Pediatric acute myeloid leukemia: final frontier for pediatric oncologists in developing world. Pediatr Hematol Oncol 2011; 28 (08) 647-648
    CrossrefPubMedGoogle Scholar
  • 10 Mohammed R, Yadav SP, Meena L, Verma IC, Sachdeva A. PUB-0194, cytogenetic findings in acute myeloid leukemia: a developing country experience. Abstracts of the 45th Congress of the International Society of Paediatric Oncology (SIOP) 2013. Hong Kong, China. September 25–28, 2013. Pediatr Blood Cancer 2013; 60 (Suppl. 03) 228
    Google Scholar
  • 11 Kota R, Linga VG, Gullipalli M. et al. PUB-0228, outcome of childhood acute myeloid leukaemia-Institutional experience from Indian subcontinent. Abstracts of the 45th Congress of the International Society of Paediatric Oncology (SIOP) 2013. Hong Kong, China. September 25–28, 2013. Pediatr Blood Cancer 2013; 60 (Suppl. 03) 236
    Google Scholar
  • 12 Sharawat SK, Bakhshi R, Vishnubhatla S, Gupta R, Bakhshi S. FLT3-ITD mutation in relation to FLT3 expression in pediatric AML: a prospective study from India. Pediatr Hematol Oncol 2014; 31 (02) 131-137
    CrossrefPubMedGoogle Scholar
  • 13 Jain K, Udgire S, Mudaliar S, Swami A, Shah N. EP-316, maintenance therapy in acute myeloid leukemia: experience from a developing country. 46(th) Congress of The International Society of Paediatric Oncology (SIOP) 2014 Toronto, Canada, 22(nd) -25(th) October, 2014 SIOP Abstracts. Pediatr Blood Cancer 2014; 61 (Suppl. 02) 324
    Google Scholar
  • 14 Jayabose S, Kasi VT, Vignesh SR, Priya R, Rathnam K. EP-317, Use of codified MRC-10 protocol for acute myeloblastic leukemia in Indian children. 46(th) Congress of The International Society of Paediatric Oncology (SIOP) 2014 Toronto, Canada, 22(nd) -25(th) October, 2014 SIOP Abstracts. Pediatr Blood Cancer 2014; 61 (Suppl. 02) 324
    Google Scholar
  • 15 Siddaiahgari S, Jillella B, Manikyam A. EP-327, Improving survival rates of acute myeloid leukemia in developing countries using AML_15 protocol. 46(th) Congress of The International Society of Paediatric Oncology (SIOP) 2014 Toronto, Canada, 22(nd) -25(th) October, 2014 SIOP Abstracts. Pediatr Blood Cancer 2014; 61 (Suppl. 02) 326
    PubMedGoogle Scholar
  • 16 Philip C, George B, Ganapule A. et al. Acute myeloid leukaemia: challenges and real world data from India. Br J Haematol 2015; 170 (01) 110-117
    CrossrefPubMedGoogle Scholar
  • 17 Radhakrishnan V, Thampy C, Ganesan P. et al. Acute myeloid leukemia in children: experience from tertiary cancer centre in India. Indian J Hematol Blood Transfus 2016; 32 (03) 257-261
    CrossrefPubMedGoogle Scholar
  • 18 Ramamoorthy J, Trehan A, Bansal D, Varma N, Jain R. PD-053, acute myeloid leukemia: treatment related mortality is abane in a developing country. 47th Congress of the International Society of Paediatric Oncology (SIOP) Cape Town, South Africa, October 8–11, 2015. Pediatr Blood Cancer 2015; 62 (Suppl. 04) 223
    Google Scholar
  • 19 Seth R, Pathak N, Singh A, Chopra A, Kumar R, Kalaivani M. Pediatric acute myeloid leukemia: improved survival rates in India. Indian J Pediatr 2017; 84 (02) 166-167 [Internet]
    CrossrefPubMedGoogle Scholar
  • 20 Narula G, Prasad M, Jatia S. et al. Clinicoepidemiological profiles, clinical practices, and the impact of holistic care interventions on outcomes of pediatric hematolymphoid malignancies - a 7-year audit of the pediatric hematolymphoid disease management group at Tata Memorial Hospital. Indian J Cancer 2017; 54 (04) 609-615
    CrossrefPubMedGoogle Scholar
  • 21 Naseer M, Ankit P, Purva K, Shraddha C. VP K. PO-012, acute myeloid leukemia: correlation of cytogenetics and outcome in a tertiary care pediatric centre. Abstracts From the 49th Congress of the International Society of Paediatric Oncology (SIOP) Washington, DC, USA October 12–15, 2017. Pediatr Blood Cancer. 2017; 64 (Suppl. 03) S442
    Google Scholar
  • 22 Kapoor R, Yadav SP. Genetics-based risk stratification of pediatric acute myeloid leukemia in India. Indian Pediatr 2018; 55 (11) 1006-1007
    PubMedGoogle Scholar
  • 23 Peyam S, Trehan A, Jain R, Bansal D, Varma N. PO-205, acute myeloid leukemia: incremental improvement in outcome in a developing country. Abstracts from the 50th Congress of the International Society of Paediatric Oncology (SIOP) Kyoto, Japan November 16–19, 2018. Pediatr Blood Cancer. 2018; (Suppl. 02) S186
    Google Scholar
  • 24 Sinha S, Brattström G, Palat G. et al. Treatment adherence and abandonment in acute myeloid leukemia in pediatric patients at a low-resource cancer center in India. Indian J Med Paediatr Oncol 2019; 40 (04) 501-506
    Article in Thieme ConnectGoogle Scholar
  • 25 Uppuluri R, Swaminathan V, Ravichandran N. et al. Chemotherapy for childhood acute myeloid leukemia and associated infections over two decades in India: timeline and impact on outcome. Indian J Med Paediatr Oncol 2020; 41 (06) 869-873
    Article in Thieme ConnectGoogle Scholar
  • 26 Srinivasan S, Dhamne C, Moulik N. , et al. 0037 / #975. A host-factor based approach impacts survival of children with acute myeloid leukemia (AML) at high-risk for induction mortality and/or early treatment abandonment. Abstracts from the 52th Congress of the International Society of Paediatric O. Pediatr Blood Cancer. 2020; 67 (Suppl. 04) S22
    Google Scholar
  • 27 Radhakrishnan V, Ganesan P, Rajendranath R, Ganesan TS, Sagar TG. Nutritional profile of pediatric cancer patients at Cancer Institute, Chennai. Indian J Cancer 2015; 52 (02) 207-209
    CrossrefPubMedGoogle Scholar
  • 28 WHO estimates of acute leukemia.. Data [Internet][Cited on 2022 Jan 5]. Accessed July 12, 2022 from: https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=continents&population=900&populations=356&key=asr&sex=0&cancer=39&type=0&statistic=5&
    Google Scholar
  • 29 Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2010; 47 (12) 1005-1010
    CrossrefPubMedGoogle Scholar
  • 30 Gupta S, Yeh S, Martiniuk A. et al. The magnitude and predictors of abandonment of therapy in paediatric acute leukaemia in middle-income countries: a systematic review and meta-analysis. Eur J Cancer 2013; 49 (11) 2555-2564 [Internet]
    CrossrefPubMedGoogle Scholar
  • 31 Atun R, Bhakta N, Denburg A. et al. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21 (04) e185-e224
    CrossrefPubMedGoogle Scholar
  • 32 Jatia S, Narula G, Sankaran H. et al. Holistic support coupled with prospective tracking reduces abandonment in childhood cancers: a report from India. Pediatr Blood Cancer 2018; 2019: 1-8
    Google Scholar
  • 33 Howard SC, Zaidi A, Cao X. et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol 2018; 19 (05) e252-e266 [Internet]
    CrossrefPubMedGoogle Scholar
  • 34 Gibson BES, Webb DKH, Howman AJ, De Graaf SS, Harrison CJ, Wheatley K. United Kingdom Childhood Leukaemia Working Group and the Dutch Childhood Oncology Group. Results of a randomized trial in children with acute myeloid leukaemia: medical research council AML12 trial. Br J Haematol 2011; 155 (03) 366-376
    CrossrefPubMedGoogle Scholar
  • 35 Creutzig U, Zimmermann M, Reinhardt D, Michael D, Stary J, Lehrnbecher T. Early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analysis of the multicenter clinical early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analysis. J Clin Oncol 2004; 2004 (22) 4384-4393
    CrossrefPubMedGoogle Scholar
  • 36 Rubnitz JE, Kaspers GJL. How I treat pediatric acute myeloid leukemia. Blood 2021; 138 (12) 1009-1018
    CrossrefPubMedGoogle Scholar
  • 37 Klein K, Van Litsenburg RRL, de Haas V. et al. Causes of early death and treatment-related death in newly diagnosed pediatric acute myeloid leukemia: recent experiences of the Dutch Childhood Oncology Group. Pediatr Blood Cancer 2019; 2020: 1-10
    Google Scholar
  • 38 Bansal D, Davidson A, Supriyadi E, Njuguna F, Ribeiro RC, Kaspers GJL. SIOP PODC adapted risk stratification and treatment guidelines: recommendations for acute myeloid leukemia in resource-limited settings. Pediatr Blood Cancer 2019; (October): e28087
    PubMedGoogle Scholar
  • 39 Sonowal R, Gupta V. Nutritional status in children with acute lymphoblastic leukemia, and its correlation with severe infection. Indian J Cancer 2021; 58 (02) 190-194
    PubMedGoogle Scholar
  • 40 Tandon S, Moulik NR, Kumar A, Mahdi AA, Kumar A. Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia. Indian Pediatr 2015; 52 (05) 385-389
    CrossrefPubMedGoogle Scholar
  • 41 Singh R, Bakhshi S. (InPOG) e collaborative research in India comes of age. Pediatr Hematol Oncol J 2016; 1 (01) 13-17
    CrossrefGoogle Scholar