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Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group. J Clin Oncol 2012 May 10;30(14):1663-9 PMID: 22412151 PMCID: PMC3383113

Pubmed ID

22412151

DOI

10.1200/JCO.2011.37.8018

Abstract

PURPOSE: To 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 METHODS: In 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.

RESULTS: Five-year survival rates increased from 83.7% in 1990-1994 to 90.4% in 2000-2005 (P < .001). Survival improved significantly in all subgroups (except for infants age ≤ 1 year), including males and females; those age 1 to 9 years, 10+ years, or 15+ 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.

CONCLUSION: This 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.

Author List

Hunger SP, Lu X, Devidas M, Camitta BM, Gaynon PS, Winick NJ, Reaman GH, Carroll WL

Author

Bruce M. Camitta MD Clinical Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-84863772728   462 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Antineoplastic Combined Chemotherapy Protocols
Cause of Death
Child
Child, Preschool
Clinical Trials as Topic
Cohort Studies
Disease Progression
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
National Cancer Institute (U.S.)
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Factors
Survival Analysis
Time Factors
Treatment Outcome
United States
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e