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Acute lymphoblastic leukaemia: the Wellington experience 1980-92
Insights
Improved treatment protocols significantly boosted survival rates for children with acute lymphoblastic leukaemia (ALL). Children treated after August 1986 showed dramatically better outcomes than those treated earlier.
Area of Science:
- Pediatric Oncology
- Hematology
Background:
- Acute lymphoblastic leukaemia (ALL) is a common childhood cancer.
- Treatment protocols evolve over time, necessitating outcome evaluation.
Purpose of the Study:
- To compare treatment outcomes for childhood ALL between two distinct periods (1980-1986 and 1986-1992) using different treatment protocols.
- To assess the impact of treatment protocol changes on survival rates in pediatric ALL patients.
Main Methods:
- Retrospective analysis of 58 pediatric ALL cases from the Wellington regional oncology unit.
- Comparison of overall survival and disease-free survival between patients treated before and after August 1986.
Main Results:
- Patients treated after August 1986 demonstrated significantly higher actuarial survival (93%) and disease-free survival (88%) compared to those treated before (53% and 47%, respectively).
- The observed improvements were not attributable to differences in patient demographics or disease risk factors.
Conclusions:
- Intensified induction and consolidation phases of ALL treatment significantly enhance outcomes for standard and high-risk pediatric patients.
- Decentralized maintenance therapy, with strong regional links, does not compromise outcomes and can be managed at local hospitals.
Aims:
The study was designed to compare two populations of children with acute lymphoblastic leukaemia treated in the Wellington regional oncology unit over two six year periods, 1980-6 and 1986-92 when two different treatment protocols were used.
Methods:
Fifty-eight cases were identified from the children's cancer registry and the relevant data collected from the hospital records. Overall survival and disease free survival in the two populations were compared.
Results:
There was a significant difference for both outcomes between the two study populations, those treated prior to August 1986 having an actuarial survival of 53% and a disease free survival of 47% compared with 93% and 88% in those children treated after August 1986 (p=0.01 and 0.001 respectively). This was not explained by differences in sex, age, area of residence at diagnosis or disease risk.
Conclusions:
Increased intensity and duration of the induction and consolidation phase of treatment has significantly improved outcome for standard and high risk disease in children who have received the intensive phases of this treatment at a regional paediatric oncology centre. Outcome is not compromised if children receive the less intensive maintenance therapy close to their homes at the district or base hospital and close links are maintained with the regional unit.
