Prognosis is an estimate of the chance for cure. It helps determine how aggressive the treatment needs to be to have the best chance for cure with the least chance of late effects. The appropriate treatment for each child with AML is determined by analyzing several features related to the child and to the leukemia cells.

Treatment for AML has dramatically improved in the last two decades. Today, 85 to 90% of children who receive optimal treatment at a major children’s hospital achieve remission. Of the children who achieve remission, 55 to 65% remain in remission for five years or more. However, there is a wide range of prognoses based on the type of AML that children have.

The WBC count at diagnosis helps predict response to treatment; a high WBC sometimes makes remission harder to achieve. Other factors that might predict more difficulty reaching remission are:

• Secondary AML: AML that develops after treatment for another cancer.
• Certain leukemia cell characteristics: Children with the following traits found in their leukemia cells have a less favorable prognosis: monosomy 7, monosomy 5/del(5q), 3q abnormalities, and FLT3-ITD with high-allelic ratio.
• Race/ethnicity: Black and Hispanic children tend to have lower survival rates than white children.
• Weight: Children who are very underweight or overweight at diagnosis can develop more life-threatening infections during treatment.

Factors that predict a higher likelihood of achieving remission are:

• Age: Children between the ages of 2 and 11 have better prognoses than do teenagers or infants.
• Rapid response to treatment: Minimum residual disease (MRD) is measured after the first phase of treatment (called induction). Children who have low MRD (called a rapid response to treatment) have a better prognosis.
• APL: Children with APL who are treated with all-trans retinoic acid (ATRA) and chemotherapy have a good prognosis, despite the fact that almost half of them have WBCs above 100,000 μL at diagnosis.
• Down syndrome: Most children with Down syndrome and AML are diagnosed when younger than four years old. This group of children has a very favorable prognosis.
• Certain leukemia cell characteristics: Children with the following traits found in their leukemia cells have a favorable prognosis: t(8;21); t(15;17); inv(16); CEBPA mutations, and NPM1 mutations.

Your child’s treatment team will consider a multitude of factors to determine your child’s prognosis and treatment options.