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

Acute myeloid leukemia is uncommon in the pediatric population. Unlike the majority of pediatric leukemia patients, young patients with acute myeloid leukemia have not seen significant improvement in treatment outcomes. In both the adult and pediatric population, few novel treatments have developed in the past decades. For this reason, patients continue to have poor outcomes with overall survival well below pediatric patients with acute lymphoblastic leukemia. This is frequently attributed to the heterogeneity of this malignancy in terms of mutations and molecularly defined categories. Instead, broader cellular features of acute myeloid leukemia, such as altered metabolic and anti-apoptotic properties have been considered in designing new treatment strategies. Therefore, further study of cytogenetics, metabolism, and molecular properties have become increasingly important in the development and tailoring of new therapeutic options. Although some of the characteristics of adult-onset myeloid leukemia resemble those of the pediatric population, their differences should be further characterized in order to individualize treatment and improve outcome. Here we will highlight unique features of pediatric acute myeloid leukemia biology and potential ties to metabolism, as well as recent advances in therapy.