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Leukaemia survival trends in children with Down's syndrome in Great Britain, 1971-2000: a population-based study
Anjali Shah1, Charles Stiller, Donna Lancaster
1Non-communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. anjali.shah@lshtm.ac.uk
Insights
Survival rates for childhood leukaemia have improved significantly. Children with Down
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Epidemiology
Background:
- Historically, children with Down's syndrome (DS) diagnosed with leukaemia faced poorer prognoses.
- Treatment limitations, including reduced chemotherapy, were previously applied to some children with DS and leukaemia.
Purpose of the Study:
- To evaluate trends in 5-year survival for childhood leukaemia in children with and without Down's syndrome.
- To analyze survival data from a large population-based cohort in Great Britain.
Main Methods:
- Population-based study analyzing leukaemia survival trends.
- Inclusion of children diagnosed between 1971 and 2000, with follow-up to 2004.
- Comparison of 5-year survival rates between children with and without DS.
Main Results:
- Overall 5-year survival for childhood leukaemia has dramatically increased across the study period.
- For lymphoid leukaemia, survival improved in children with DS but remains lower than in their non-DS peers (59% vs 83% in 1996-2000).
- For acute non-lymphoblastic leukaemia (ANLL), 5-year survival for children with DS surged from <1% to over 80% by the 1990s, surpassing the increase seen in non-DS children (6% to 64%).
Conclusions:
- While overall survival has improved, the poorer outcome for lymphoid leukaemia in children with DS warrants further investigation.
- Significant ANLL survival gains in children with DS are attributed to increased clinical trial participation, evolving clinical practices, and favourable leukaemic biology.
- The improved response of myeloid leukaemia in young children with DS to certain chemotherapeutic agents contributes to better outcomes.
Background:
Children with Down's syndrome (DS) who developed leukaemia have had a worse prognosis than other children with leukaemia in the past. In the 1970s and early 1980s, some children with DS who developed leukaemia received fewer cycles of chemotherapy or were advised not to have treatment.
Methods:
In this population-based study, trends in 5-year survival from leukaemia were evaluated for children with and without DS who were diagnosed in Great Britain during 1971-2000 and followed to the end of 2004.
Results:
For all children, with and without DS, survival has increased dramatically over the 30 year study period. For lymphoid leukaemia, survival in children with DS increased, but remains lower than for other children (5-year survival 59% vs 83% during 1996-2000). For acute non-lymphoblastic leukaemia (ANLL), however, 5-year survival improved substantially for children with DS, from less than 1% in the early 1970s to over 80% in the 1990s. For other children, survival increased from 6% to 64% during the same period.
Conclusion:
Survival for all children diagnosed with leukaemia has improved during the last three decades. For lymphoid leukaemia, the inferior outcome observed on more recent treatment protocols in children with DS remains an area for concern. For ANLL, the improvement in survival for children with DS is due to a number of factors, namely increased recruitment of these children to clinical trials, changes in clinical practice and important differences in the biology of myeloid leukaemia in young children with DS, resulting in a better response to some chemotherapeutic agents.
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