Pediatric acute myeloid leukemia in Uruguay: clinical outcomes and diagnostic challenges in a national cohort (2008-2024).

BACKGROUND

Outcomes for pediatric acute myeloid leukemia (AML) have improved substantially in high-income countries through advances in therapy, supportive care, and risk stratification. In Uruguay, results remain poorer despite adopting international protocols. This study evaluates clinical features and outcomes of pediatric AML in Uruguay, establishing a baseline before implementation of the CHIP-AML22 protocol in 2025.

RESEARCH DESIGN AND

METHODS

A retrospective analysis was conducted using data from the National Pediatric Cancer Registry. Patients under 18 years diagnosed with AML between January 2008 and December 2024 were included. Treatment followed St. Jude AML08 and CLCN-UK 2016 protocols. High-risk or relapsed patients received allogeneic stem cell transplantation.

RESULTS

Ninety-two patients were diagnosed with AML, including 7 with Down syndrome and 19 with acute promyelocytic leukemia (APL). Among 66 AML patients, excluding DS and APL, induction failure occurred in 24% (12% early death, 12% refractory disease), relapse in 24%, and treatment-related mortality accounted for 73% of deaths. Five-year overall survival was 50% and event-free survival 38%.

CONCLUSIONS

Pediatric AML survival in Uruguay remains below international benchmarks, mainly due to treatment-related mortality during induction. Implementation of CHIP-AML22, together with stronger induction management and supportive care, offers opportunities to improve survival and narrow this gap.