Clinical outcomes and prognostic factors in pediatric acute myeloid leukemia with monocytic differentiation: a single-center cohort study from Egypt
5 affiliations
- 1Department of Clinical Oncology and Nuclear Medicine, Sohag University, Sohag, Egypt
- 2Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- 3Department of Pediatric Oncology, Children’s Cancer Hospital, Cairo, Egypt
- 4Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
- 5Department of Clinical Pathology, Children’s Cancer Hospital, Cairo, Egypt
Abstract
Background: Acute myeloid leukemia (AML) with monocytic differentiation (FAB M4/M5 subtypes) is a distinct subtype of pediatric AML characterized by aggressive clinical behavior and common extramedullary involvement. Despite therapeutic advances, outcomes remain suboptimal, particularly in resource-limited settings. The study aimed to evaluate the clinical characteristics, treatment outcomes, and prognostic markers in pediatric patients with AML, FAB M4/M5 subtypes.
Patients and methods: A retrospective cohort study analyzing 193 patients with AML, FAB M4/M5 subtypes diagnosed at the Children’s Cancer Hospital, Egypt-57357 (CCHE-57357) between January 2016 and December 2021.
Results: The cohort comprised 131 patients with M4 and 62 with M5 morphology. Median follow-up was 62.0 months among survivors and 37.6 months for the entire cohort. Three- and five-year OS were 53.1% and 48.3%; three- and five-year EFS were 48.2% and 45.5%. Five-year CIR was 23.8%. Forty-eight patients (24.9%) died during induction. Multivariate Cox regression identified MRD positivity after first induction (HR 2.868, 95% CI 1.133–7.260, p = 0.026) and monosomy 7 (HR 6.206, 95% CI 2.692–14.306, p < 0.001) as independent adverse prognostic factors. Conversely, inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB::MYH11 was an independent favorable prognostic factor (HR 0.253, 95% CI 0.108–0.592, p = 0.002). 14 high-risk pediatric AML patients underwent HSCT post-induction; three experienced adverse outcomes, comprising relapses (n = 2), and acute GVHD (n = 1).
Conclusion: Genetic findings and treatment response were associated with outcome, supporting a complete diagnostic assessment. Improving survival requires precise risk stratification, MRD-guided therapy, and robust supportive care.
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BibTeX
@article{ahmed2026clinical,
title = {{Clinical outcomes and prognostic factors in pediatric acute myeloid leukemia with monocytic differentiation: a single-center cohort study from Egypt}},
author = {Tarek Ahmed Abdelrehim Ahmed and Mahmoud Hammad and Sonya Soliman and Nahla Elsharkawy and Sherine Ibrahim Salem and Sonia Ahmed and Alaa Elhaddad},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1969723},
url = {https://doi.org/10.3389/fonc.2026.1969723},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical outcomes and prognostic factors in pediatric acute myeloid leukemia with monocytic differentiation: a single-center cohort study from Egypt
AU - Tarek Ahmed Abdelrehim Ahmed
AU - Mahmoud Hammad
AU - Sonya Soliman
AU - Nahla Elsharkawy
AU - Sherine Ibrahim Salem
AU - Sonia Ahmed
AU - Alaa Elhaddad
PY - 2026
DA - 2026/10/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1969723
UR - https://doi.org/10.3389/fonc.2026.1969723
AB - Background: Acute myeloid leukemia (AML) with monocytic differentiation (FAB M4/M5 subtypes) is a distinct subtype of pediatric AML characterized by aggressive clinical behavior and common extramedullary involvement. Despite therapeutic advances, outcomes remain suboptimal, particularly in resource-limited settings. The study aimed to evaluate the clinical characteristics, treatment outcomes, and prognostic markers in pediatric patients with AML, FAB M4/M5 subtypes. Patients and methods: A retrospective cohort study analyzing 193 patients with AML, FAB M4/M5 subtypes diagnosed at the Children’s Cancer Hospital, Egypt-57357 (CCHE-57357) between January 2016 and December 2021. Results: The cohort comprised 131 patients with M4 and 62 with M5 morphology. Median follow-up was 62.0 months among survivors and 37.6 months for the entire cohort. Three- and five-year OS were 53.1% and 48.3%; three- and five-year EFS were 48.2% and 45.5%. Five-year CIR was 23.8%. Forty-eight patients (24.9%) died during induction. Multivariate Cox regression identified MRD positivity after first induction (HR 2.868, 95% CI 1.133–7.260, p = 0.026) and monosomy 7 (HR 6.206, 95% CI 2.692–14.306, p < 0.001) as independent adverse prognostic factors. Conversely, inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB::MYH11 was an independent favorable prognostic factor (HR 0.253, 95% CI 0.108–0.592, p = 0.002). 14 high-risk pediatric AML patients underwent HSCT post-induction; three experienced adverse outcomes, comprising relapses (n = 2), and acute GVHD (n = 1). Conclusion: Genetic findings and treatment response were associated with outcome, supporting a complete diagnostic assessment. Improving survival requires precise risk stratification, MRD-guided therapy, and robust supportive care.
SN - 2234-943X
ER -