Improved Survival for Children and Adolescents With Acute Lymphoblastic Leukemia Between 1990 and 2005: A Report From the Children's Oncology Group

Abstract

A B S T R A C T PurposeTo examine population-based improvements in survival and the impact of clinical covariates on outcome among children and adolescents with acute lymphoblastic leukemia (ALL) enrolled onto Children's Oncology Group (COG) clinical trials between 1990 and 2005. Patients and MethodsIn total, 21,626 persons age 0 to 22 years were enrolled onto COG ALL clinical trials from 1990 to 2005, representing 55.8% of ALL cases estimated to occur among US persons younger than age 20 years during this period. This period was divided into three eras (1990-1994, 1995-1999, and 2000-2005) that included similar patient numbers to examine changes in 5-and 10-year survival over time and the relationship of those changes in survival to clinical covariates, with additional analyses of cause of death. ResultsFive-year survival rates increased from 83.7% in 1990-1994 to 90.4% in 2000-2005 (P Ͻ .001). Survival improved significantly in all subgroups (except for infants age Յ 1 year), including males and females; those age 1 to 9 years, 10ϩ years, or 15ϩ years; in whites, blacks, and other races; in Hispanics, non-Hispanics, and patients of unknown ethnicity; in those with B-cell or T-cell immunophenotype; and in those with National Cancer Institute (NCI) standard-or high-risk clinical features. Survival rates for infants changed little, but death following relapse/disease progression decreased and death related to toxicity increased. ConclusionThis study documents ongoing survival improvements for children and adolescents with ALL. Thirty-six percent of deaths occurred among children with NCI standard-risk features emphasizing that efforts to further improve survival must be directed at both high-risk subsets and at those children predicted to have an excellent chance for cure.

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

“…The acute lymphoblastic leukemia (ALL) is the malignant tumor with the highest incidence in the childhood, although the risk-stratification chemotherapy has significantly improved the prognosis, the event-free survival (EFS) and overall survival (OS) have been significantly improved, the recurrence and disease progression, as well as the drug toxicity -related mortality, are still increasing (Hunger et al, 2012). The recent studies have found that during the child critical disease process, the incidence of hyperglycemia was one of the risk factors that would affect the prognosis (Devos and Preiser, 2004;Faustino and Apkon, 2005), and the similar conclusion had been confirmed in the adult malignancies (Ali et al, 2007), the hyperglycemia might directly affect the cell growth, and induce the drug resistance of tumor cells (Feng et al, 2011).…”

Seven great achievements in pediatric research in the past 40 y

“…Although prior to 1950, the diagnosis of childhood leukemia was uniformly fatal and in the 1960s survival was only 15-20%, survival rates for childhood ALL have now reached 90% (26). Figure 2 shows the dramatic decline in mortality rates for ALL and other pediatric cancers.…”

“…After developing special tools to measure surface Gestational age (weeks) 26 Special Article tension, he identified pulmonary surfactant (first called the "anti-atelectasis factor") (40). Avery and Mead made the seminal discovery that surfactant was absent from the lungs of infants who died from RDS, but present in infants who died without pulmonary disease (41).…”

Clinically defining and managing high-risk pediatric patients with acute lymphoblastic leukemia

“…Boys, irrespective of risk of testicular relapse, have a slightly inferior outcomes compared with girls. 26 Black and Hispanic children with ALL have been shown to have an inferior outcome compared with Caucasian and Asian children. 27 The reasons underlying these disparities are likely multiple, but include variations in ALL subtypes, host polymorphisms, and sociodemographic factors.…”