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Published on: October 17, 2025
Outcome of Pediatric Acute Lymphoblastic Leukemia: Sixty Years of Progress
Ewa Demidowicz1, Monika Pogorzała1, Monika Łęcka1
1Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Jurasz University Hospital, Bydgoszcz, Poland.
Insights
Survival rates for pediatric acute lymphoblastic leukemia (ALL) have dramatically improved over six decades. Advances in the therapeutic era, linked to economic growth, significantly predict better overall survival (OS) for children with ALL.
Area of Science:
- Pediatric Oncology
- Hematology
- Epidemiology
Background:
- Investigated survival outcomes in pediatric acute lymphoblastic leukemia (ALL) over a 60-year period.
- Hypothesized improvements linked to therapeutic advancements, economic growth (GDP), and human development (HDI).
Purpose of the Study:
- To analyze survival trends in pediatric ALL patients across different treatment eras.
- To determine the impact of the therapeutic era, GDP, and HDI on survival outcomes.
Main Methods:
- Retrospective analysis of 710 pediatric ALL patients treated between 1958 and 2018.
- Evaluation of 5-year overall survival (pOS), event-free survival (pEFS), and relapse risk (pRR) across seven therapeutic eras.
Main Results:
- 5-year overall survival (pOS) increased from 1.2% to 90.7%; event-free survival (pEFS) rose from 1.2% to 86.6%.
- Relapse risk (pRR) decreased from 98.8% to 9.9% in the most recent decade.
- Mortality risk reduced to 9.9% in the recent era; no significant survival difference between stem cell transplant and non-transplant groups.
Conclusions:
- The therapeutic era, associated with improved GDP and HDI, is a significant predictor of increased overall survival (OS) in pediatric ALL.
- Significant progress in pediatric ALL treatment outcomes has been achieved over the past 60 years.
Background:
A retrospective analysis was performed to investigate the survival outcomes in pediatric acute lymphoblastic leukemia (ALL) based on time period. We hypothesized that improvement has been obtained with the time-dependent therapeutic era and rise in the gross domestic product (GDP) and Human Development Index (HDI).
Materials And Methods:
Data from 710 children who were treated for ALL between 1958 and 2018 at a single pediatric center were analyzed for probability of 5-year overall survival (pOS), event-free survival (pEFS) and relapse risk (pRR). Time periods were defined by the treatment protocols used in seven consecutive therapeutic eras.
Results:
Over the 60-year period analyzed, pOS increased from 1.2% to 90.7%, pEFS from 1.2% to 86.6%, and pRR decreased from 98.8% to 9.9% for patients treated in the past decade. Risk of mortality for patients who received chemotherapy and hematopoietic cell transplant was reduced to 9.9% in the recent era, however, no statistically significant survival difference was found between patients treated with stem cell transplant and those not.
Conclusion:
The therapeutic era, related to improved GDP and HDI, was a statistically significant predictor of increased OS from ALL.
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