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Patterns of care and survival for children with acute lymphoblastic leukaemia diagnosed between 1980 and 1994
1Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, 57 Woodstock Road, Oxford OX2 6HJ, UK.
Insights
Survival rates for childhood acute lymphoblastic leukemia (ALL) improved significantly from 1980-1994 due to modern chemotherapy. Children enrolled in national trials showed better outcomes, highlighting the importance of treatment protocols for pediatric leukemia survival.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Epidemiology
Background:
- Childhood acute lymphoblastic leukemia (ALL) remains a significant health concern.
- Modern chemotherapy has advanced treatment protocols for pediatric cancers.
- Understanding survival rates and prognostic factors is crucial for improving outcomes.
Purpose of the Study:
- To document survival rates for childhood ALL during the modern chemotherapy era.
- To assess the impact of prognostic factors at diagnosis on survival.
- To investigate the relationship between the organization of care and survival outcomes.
Main Methods:
- Analysis of a population-based series of 4988 children diagnosed with ALL in the UK between 1980 and 1994.
- Calculation of actuarial survival rates.
- Assessment of prognostic factors including age, sex, white blood cell count, immunophenotype, and Down's syndrome status.
Main Results:
- Five-year survival for childhood ALL improved from 67% (1980-1984) to 81% (1990-1994), a 42% reduction in mortality risk.
- Treatment at paediatric oncology centres increased from 77% to 89%, and participation in national trials rose from 59% to 82% during the study period.
- Children entered into national trials demonstrated significantly higher survival rates, with the difference widening over time.
Conclusions:
- Survival rates for childhood ALL continue to improve, with substantial gains observed over the study period.
- Survival outcomes are not significantly associated with hospital treatment volume or type.
- Enrollment in national clinical trials is a key factor associated with improved survival in pediatric ALL.
Aims:
To document survival rates after acute lymphoblastic leukaemia (ALL) during the era of modern chemotherapy, to assess effects of prognostic factors at presentation, and to investigate the relation of survival to patterns of organisation of care.
Patients:
From a population based series of 5078 children diagnosed in the UK during 1980-94, 4988 remained for analysis after exclusion of nine children ascertained from death certificates alone and 81 who received no antileukaemia treatment.
Main Outcome Measures:
Actuarial survival rates.
Results:
Between 1980-84 and 1990-94, the proportion of children treated at paediatric oncology centres rose from 77% to 89%, and the proportion entered into national trials rose from 59% to 82%. Each of age, sex, white blood count, immunophenotype, and Down's syndrome status had a highly significant effect on survival. Five year survival improved from 67% in 1980-84 to 81% in 1990-94, a 42% reduction in the risk of death within five years of diagnosis. Survival did not differ significantly between hospitals with different numbers of new patients per year or between paediatric oncology centres and other hospitals. Children who were entered into national trials had higher survival and this difference became greater in recent years; five year survival rates for children diagnosed during 1980-84 were 70% and 64% for trial and non-trial patients, respectively; in 1990-94 the rates were 84% and 68% for trial and non-trial patients, respectively.
Conclusions:
Survival after ALL continues to improve. Nearly 50 children/year diagnosed during 1990-94 survived who would have died a decade before. Survival does not vary systematically with place of treatment but is higher for children entered into national trials.
