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Treatment centre size, entry to trials, and survival in acute lymphoblastic leukaemia
1Department of Paediatrics, University of Oxford.
Insights
Improved survival rates for childhood acute lymphoblastic leukaemia are linked to increased participation in clinical trials and treatment at high-volume centers. Standardized protocols significantly impact childhood leukaemia mortality.
Area of Science:
- Pediatric Oncology
- Clinical Epidemiology
Background:
- Childhood acute lymphoblastic leukaemia (ALL) survival rates have historically varied.
- The impact of treatment centralization and clinical trial participation on ALL outcomes requires further elucidation.
Purpose of the Study:
- To evaluate the association between treatment at specialized centers, participation in Medical Research Council (MRC) trials, and survival rates in children with acute lymphoblastic leukaemia.
- To assess trends in childhood ALL survival over an 11-year period in Britain.
Main Methods:
- Analysis of a population-based series of 4070 children diagnosed with acute lymphoblastic leukaemia in Britain between 1971 and 1982.
- Comparison of five-year survival rates based on treatment era, inclusion in MRC trials, and annual patient volume at treatment centers.
Main Results:
- Five-year survival for childhood ALL improved from 37% (1971-3) to 66% (1980-2).
- Children in MRC trials had significantly higher survival rates than those not enrolled.
- Survival rates were highest at high-volume centers (≥6 new patients/year) and lowest at low-volume centers (<1 new patient/year) among non-trial patients.
Conclusions:
- Standardized treatment protocols, particularly within controlled clinical trials, have substantially improved survival for childhood acute lymphoblastic leukaemia.
- Treatment centralization at high-volume centers is associated with better outcomes for children with ALL, even outside of formal trials.
Abstract:
In a population based series of 4070 children with acute lymphoblastic leukaemia treated in Britain during 1971-82, the five year survival rate improved from 37% for those treated in 1971-3 to 66% in 1980-2. During the same period there was an increase in the proportion of children included in the Medical Research Council trials and an increase in the proportion who were treated at centres with an average of at least six new patients per year. Survival rates were significantly higher for children who were included in the trials than for those who were not. Among children not in the trials, the survival rate was highest at centres treating at least six children per year and lowest at those with fewer than one per year. The increase in the numbers of children treated according to standardised protocols, particularly within controlled clinical trials, has had a major impact on the mortality from childhood acute lymphoblastic leukaemia.