Childhood acute myeloid leukemia with TLS::ERG fusion gene: a clinical analysis of 12 cases

To investigate the clinical characteristics and prognosis of pediatric acute myeloid leukemia (AML) with TLS::ERG fusion gene.

Clinical data from multiple pediatric hematology centers in South China were retrospectively reviewed for the period September 2015 to October 2025. Cases harboring the TLS::ERG fusion gene were identified and analyzed.

Among 875 children with AML, 12 (1.4%) were TLS::ERG positive; there were 6 males and 6 females, with a median age of 88 months. The complete remission rate after 2 induction courses was 83% (10/12). Six patients relapsed, yielding a relapse rate of 50% (6/12). Four patients remained disease-free, six died after relapse, and two were lost to follow-up. The 5-year overall survival and event-free survival were 38.4% (95%CI: 16.8%-87.8%) and 30.0% (95%CI: 12.0%-74.7%), respectively.

Pediatric AML with TLS::ERG fusion is rare, shows a high early induction remission rate, but has a high relapse rate and poor prognosis.