Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Abstract

Proportion cured is a potentially more informative cancer outcome measurement than 5-year survival. We present population-based estimates of cure for young patients diagnosed with acute lymphoblastic leukemia in Europe from 1982 to 2002. Thirty-five European cancer registries provided data. Survival was estimated by age, period of diagnosis and European region, and used as input for parametric cure models, which assume cured patients have the same mortality as the general population. For acute lymphoblastic leukemia diagnosed in 1-14 year olds in 2000-2002, over 77% were estimated cured. The proportion cured improved significantly over the study period: an impressive 26-58% in infants (up to 1 year), 70-90% in 1-4 year olds, 63-86% in 5-9 year olds, 52-77% in 10-14 year olds, and 44-50% in 15-24 year olds. Regional variations in proportion cured reduced over time for 1-14 year-olds, but persisted in infants and 15-24 year olds. Five-year survival was always slightly higher than proportion cured. Considerable proportions of young patients were estimated cured of acute lymphoblastic leukemia. Nevertheless, a small excess risk of death persisted beyond five years after diagnosis when patients remained at risk for late treatment effects, late relapses and second primaries

Dexrazoxane for reducing anthracycline-related cardiotoxicity in children with cancer: An update of the evidence

“…Clinical and subclinical cardiovascular damage, heart failure, coronary artery disease, and cerebrovascular events are treatment-related health complications in survivors of childhood cancer [3,5,12,[15][16][17]. Cumulative doses of anthracycline of 300 mg/m 2 or higher increase the risk of cardiomyopathy, valve disorders, and conduction abnormalities over that of unexposed survivors; radiotherapy is an added risk factor [18][19][20].…”

“…Some of the most comprehensive epidemiological data come from population-based studies in Europe and the US [3,5,12,15,28,29]. In the US, for example, the number of childhood cancer survivors was almost 380,000 in 2010, an increase of 15% from the estimated number in 2005 [1,28].…”

Cure trends in acute lymphoblastic leukemia: is it time for a revised concept of cure?

“…1 The good news is that the projected proportion of cured children increased significantly over the study period, especially in children in the good prognosis age groups: from 70% to 90% in 1-4 year olds, and from 63% to 86% in 5-9 year olds. The projected outcome data for children below the age of one year and for older children/young adolescents was less satisfactory with increases from 26 to 58% for infants, 52% to 77% for 10-14 year olds, and 44% to 50% for 15-24 year olds.…”

“…1 In some subgroups, patient numbers were very low, especially when assessing regional variations for infants and older children, questioning the reliability of these results. Access to treatment and potentially ethnic variation may be important contributors to these regional variations.…”

“…Unfortunately, the cancer registries to date do not capture data on immunophenotype nor on the genetic abnormalities in the leukemic cells, and hence these data could not be analyzed by Gatta et al 1 We feel that such data should be obtained in the future, as genotype-specific therapies are emerging, such as the aforementioned use of TKIs, and hence it becomes clinically important to follow cure trends by genotype rather than the classical features such as age.…”