Therapeutic Outcomes of Pediatric Acute Myeloblastic Leukemia Patients at a Tertiary Hospital in Bandung, Indonesia

Filbert Lois Marcus, Nur Suryawan, Delita Prihatni


Background: Acute myeloblastic leukemia (AML) is a subtype of leukemia characterized by myeloid infiltration into the bone marrow, blood, and other tissues. AML ranks 5th malignancy in children and the prognosis is poor. After chemotherapy, the outcomes vary. Therefore, this study aimed to provide further insight into the therapeutic outcomes of pediatric AML patients.

Methods: This study was conducted with a cross-sectional descriptive method. The data were obtained from the medical records of children diagnosed with AML at the Department of Child Health of Dr. Hasan Sadikin General Hospital in 2017–2019 with the total sampling method. Data including age at determination, gender, laboratory values including hemoglobin, leukocyte, thrombocyte as well as blast cell count on peripheral blood smear were collected. Also, the bone marrow punctures gathered were clustered based on the French-American-British (FAB) classification. Data were presented in tables.

Results: In total, 46 data of AML patients were retrieved, with the age category at first diagnosis was >5–12 years (48%) and predominantly males (63%), children with moderate anemia (41%), leukocytosis (35%), severe thrombocytopenia (46%), and blast cell count ≥20% (83%). AML-M2 was the most common subtype (30.4%). The majority of patients (91%) underwent chemotherapy and most (45%) patients died during chemotherapy

Conclusion: The outcome of AML therapy among children is mostly poor, and particularly die during chemotherapy. Early detection and follow-up of patients to continue therapy are important aspects to reduce the mortality rate of AML.


Acute myeloblastic leukemia, child cancer, outcome of therapy

Full Text:



Lanzkowsky P, Lipton J, Fish JD, editors. Manual of pediatric hematology and oncology. 6th ed. London: Academic Press; 2016. p. 390–406.

Dores GM, Devesa SS, Curtis RE, Linet MS, Morton LM. Acute leukemia incidence and patient survival among children and adults in the United States, 2001–2007. Blood. 2012;119(1):34–43.

Sjakti HA, Gatot D, Windiastuti E. Hasil pengobatan leukemia mieloblastik akut pada anak. Sari Pediatri. 2016;14(1):40-5.

Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):83–103.

Sari NM, Reniarti L, Suryawan N, Susanah S, Wahyudi K. Burden of pediatric cancer treatment: results of online pediatric cancer registry prototype 1 at a third referral hospital in Indonesia. Althea Medical Journal. 2017;4(3):461–7.

Chen G, Wu J. Molecular classification of acute leukemia. In: Chaubey YP, editor. Proceedings of Statistics 2011 Canada/IMST 2011-FIM XX; 2011 July 1–4; Montreal, Canada. Singapore: World Scientific; 2013. p. 60–74..

Direktorat Pengendalian Penyakit Tidak Menular, Direktorat Jenderal PP & PL Kementrian Kesehatan RI. Pedoman penemuan dini kanker pada anak. Jakarta: Kementerian Kesehatan RI; 2011.

Rubnitz JE. Current management of childhood acute myeloid leukemia. Pediatr Drugs. 2017;19(1):1–10.

Sander A, Zimmermann M, Dworzak M, Fleischhack G, Von Neuhoff C, Reinhardt D, et al. Consequent and intensified relapse therapy improved survival in pediatric AML: Results of relapse treatment in 379 patients of three consecutive AML-BFM trials. Leukemia. 2010;24(8):1422–8.

Handayani K, Sitaresmi MN, Supriyadi E, Widjajanto PH, Susilawati D, Njuguna F, et al. Delays in diagnosis and treatment of childhood cancer in Indonesia. Pediatr Blood Cancer. 2016;63(12):2189–96.

Harrison CJ, Hills RK, Moorman AV., Grimwade DJ, Hann I, Webb DKH, et al. Cytogenetics of childhood acute myeloid leukemia: United Kingdom Medical Research Council Treatment Trials AML 10 and 12. J Clin Oncol. 2010;28(16):2674–81.

Barrington-Trimis JL, Cockburn M, Metayer C, Gauderman WJ, Wiemels J, McKean-Cowdin R. Trends in childhood leukemia incidence over two decades from 1992 to 2013. Int J Cancer. 2017;140(5):1000–8.

Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. Am Fam Physician. 2014;89(9):731–8.

Rahadiyanto KY, Liana P, Indriani B. Pola gambaran darah tepi pada penderita leukimia di laboratorium klinik RSUP dr. Moh. Hoesin Palembang. Maj Kedokteran Sriwijaya. 2014;46(4):259–65.

Ciesla B. Hematology in practice. 3rd ed revised. Philadelphia: FA Davis Co; 2019.

Mukda E, Pintaraks K, Sawangpanich R, Wiangnon S, Pakakasama S. FLT3 and NPM1 gene mutations in childhood acute myeloblastic leukemia. Asian Pacific J Cancer Prev. 2011;12(7):1827–31.

Støve HK, Sandahl JD, Abrahamsson J, Asdahl PH, Forestier E, Ha SY, et al. Extramedullary leukemia in children with acute myeloid leukemia: a population-based cohort study from the Nordic Society of Pediatric Hematology and Oncology (NOPHO). Pediatr Blood Cancer. 2017;64(12):1–9.

Xu XJ, Tang YM, Song H, Yang SL, Shi SW, Wei J. Long-term outcome of childhood acute myeloid leukemia in a developing country: Experience from a children’s hospital in China. Leuk Lymphoma. 2010;51(12):2262–9.

Nannya Y, Kurokawa M. [Acute myeloid leukemia]. Nihon Rinsho. 2012;70 Suppl 8:496–500.

Abrahamsson J, Forestier E, Heldrup J, Jahnukainen K, Jónsson ÓG, Lausen B, et al. Response-guided induction therapy in pediatric acute myeloid leukemia with excellent remission rate. J Clin Oncol. 2011;29(3):310–5.


Article Metrics

Abstract view : 347 times
PDF - 225 times

 This Journal indexed by


Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats