In many cancers, children under the age of 18 have better survival rates than young adults between 18 and 39. For acute myeloid leukemia (AML), a blood cancer that occurs in both children and adults, this possible difference in survival had not yet been investigated in the Dutch population.
In research and treatment for cancer, young adults are also referred to as ‘AYAs’, an abbreviation of ‘Adolescents and Young Adults’. Researchers are not yet sure why AYAs have a worse outcome than children, and in some cancers than older adults. For example, there could be differences in the disease characteristics, more harmful side effects from therapy, and later diagnosis and treatment in AYAs.
In a new study, dr. Maya Schulpen, postdoc and epidemiologist in the Karim-Kos group, studied survival rates of children and young adults with AML based on data from the Netherlands Cancer Registry. In total, she analyzed data from 675 children and 1383 young adults up to the age of 40 who were diagnosed with AML between 1990-2015.
‘We saw that the prognosis for young people with AML in the Netherlands has thankfully improved considerably in recent years,’ says Maya Schulpen. ‘But we also found that children had a significantly better prognosis than young adults. The increase in survival was also greater in children.’
In children and AYAs together, the five-year survival after AML diagnosis increased from 40% to 62% between 1990 and 2015. But there were important differences between the two age groups. In the period between 1990-1999, 49% of children survived their illness for at least five years. That number rose to 74% between 2010-2015. During the same period, survival in young adults only increased from 35% to 55%. The data also showed an increased risk of death for AYAs, even when taking into account their sex, treatment, and whether or not they were treated in an academic hospital.
More effective treatment
In follow-up research, the Karim-Kos group plans to explore the possible causes of the difference in survival between children and AYAs with AML. ‘There may be differences in the cancer itself, such as other molecular or genetic abnormalities in the malignant leukemia cells. We also think that AYAs are diagnosed less quickly, so that treatment is started later.' In addition, the lower participation of AYAs in clinical studies could be a reason, so that positive developments in the treatment of AML reach this group less quickly. Maya Schulpen: 'Hopefully with our research we can eventually provide tools for a new, more effective treatment strategy for young people with AML.'
Interested to know more about this study? Dr. Maya Schulpen explained her research in more detail in a podcast of the Nederlands Tijdschrift voor Hematologie (in Dutch).