Narrative review of targetable features of pediatric acute myeloid leukemia from molecular and metabolic perspectives.

Background and Objective: Unlike the majority of pediatric leukemia patients, young patients with acute myeloid leukemia (AML) have not seen significant improvement in treatment outcomes. This is frequently attributed to the heterogeneity of this malignancy in terms of its mutations and molecularly defined categories. In adult versus pediatric cases of AML, the heterogeneity is preserved, although there are key differences in the incidence of gene mutations, chromosomal translocations, and other molecular features. Current treatment strategies consider broader cellular features of AML, such as altered metabolic and anti-apoptotic properties, and many of these are common across pediatric and adult AML. Methods: A narrative review was conducted to compile literature regarding molecular and metabolic features of AML and new treatment modalities in the adult and pediatric population. Articles published in PubMed were gathered and studied over 6 months for review and comparison. Studies published in English over a ten-year period from 2000-2020 were included. Keywords used for the searches included acute myeloid leukemia, cytogenetics, pediatric acute myeloid leukemia, and treatment of acute myeloid leukemia. Key Content and Findings: Molecular characteristics of adult-onset myeloid leukemia as compared to those in the pediatric population are detailed. We highlight unique features of pediatric AML biology and potential ties to metabolism, as well as recent advances in therapy. Conclusions: Differences in adult and pediatric AML cytogenetics, metabolism, and molecular features should be further characterized in order to individualize treatment, develop new therapeutic options, and improve patient outcome.