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. 1999 Sep;81(3):202–208. doi: 10.1136/adc.81.3.202

Patterns of care and survival for children with acute lymphoblastic leukaemia diagnosed between 1980 and 1994

C Stiller 1, E Eatock 1
PMCID: PMC1718071  PMID: 10451391

Abstract

AIMS—To document survival rates after acute lymphoblastic leukaemia (ALL) during the era of modern chemotherapy, to assess effects of prognostic factors at presentation, and to investigate the relation of survival to patterns of organisation of care.
PATIENTS—From a population based series of 5078 children diagnosed in the UK during 1980-94, 4988 remained for analysis after exclusion of nine children ascertained from death certificates alone and 81 who received no antileukaemia treatment.
MAIN OUTCOME MEASURES—Actuarial survival rates.
RESULTS—Between 1980-84 and 1990-94, the proportion of children treated at paediatric oncology centres rose from 77% to 89%, and the proportion entered into national trials rose from 59% to 82%. Each of age, sex, white blood count, immunophenotype, and Down's syndrome status had a highly significant effect on survival. Five year survival improved from 67% in 1980-84 to 81% in 1990-94, a 42% reduction in the risk of death within five years of diagnosis. Survival did not differ significantly between hospitals with different numbers of new patients per year or between paediatric oncology centres and other hospitals. Children who were entered into national trials had higher survival and this difference became greater in recent years; five year survival rates for children diagnosed during 1980-84 were 70% and 64% for trial and non-trial patients, respectively; in 1990-94 the rates were 84% and 68% for trial and non-trial patients, respectively.
CONCLUSIONS—Survival after ALL continues to improve. Nearly 50 children/year diagnosed during 1990-94 survived who would have died a decade before. Survival does not vary systematically with place of treatment but is higher for children entered into national trials.


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Selected References

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  1. Atra A., Gerrard M., Hobson R., Imeson J. D., Ashley S., Pinkerton C. R. Improved cure rate in children with B-cell acute lymphoblastic leukaemia (B-ALL) and stage IV B-cell non-Hodgkin's lymphoma (B-NHL)--results of the UKCCSG 9003 protocol. Br J Cancer. 1998 Jun;77(12):2281–2285. doi: 10.1038/bjc.1998.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chessells J. M., Bailey C., Richards S. M. Intensification of treatment and survival in all children with lymphoblastic leukaemia: results of UK Medical Research Council trial UKALL X. Medical Research Council Working Party on Childhood Leukaemia. Lancet. 1995 Jan 21;345(8943):143–148. doi: 10.1016/s0140-6736(95)90164-7. [DOI] [PubMed] [Google Scholar]
  3. Chessells J. M., Eden O. B., Bailey C. C., Lilleyman J. S., Richards S. M. Acute lymphoblastic leukaemia in infancy: experience in MRC UKALL trials. Report from the Medical Research Council Working Party on Childhood Leukaemia. Leukemia. 1994 Aug;8(8):1275–1279. [PubMed] [Google Scholar]
  4. Chessells J. M., Harrison G., Lilleyman J. S., Bailey C. C., Richards S. M. Continuing (maintenance) therapy in lymphoblastic leukaemia: lessons from MRC UKALL X. Medical Research Council Working Party in Childhood Leukaemia. Br J Haematol. 1997 Sep;98(4):945–951. doi: 10.1046/j.1365-2141.1997.3113127.x. [DOI] [PubMed] [Google Scholar]
  5. Chessells J. M., Richards S. M., Bailey C. C., Lilleyman J. S., Eden O. B. Gender and treatment outcome in childhood lymphoblastic leukaemia: report from the MRC UKALL trials. Br J Haematol. 1995 Feb;89(2):364–372. doi: 10.1111/j.1365-2141.1995.tb03313.x. [DOI] [PubMed] [Google Scholar]
  6. Chessells J. M. Risk analysis in acute lymphoblastic leukaemia: problems and pitfalls. Eur J Cancer. 1995 Sep;31A(10):1656–1659. doi: 10.1016/0959-8049(95)00343-h. [DOI] [PubMed] [Google Scholar]
  7. Eden O. B., Lilleyman J. S., Richards S., Shaw M. P., Peto J. Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (report to the Medical Research Council on behalf of the Working Party on Leukaemia in Childhood). Br J Haematol. 1991 Jun;78(2):187–196. doi: 10.1111/j.1365-2141.1991.tb04415.x. [DOI] [PubMed] [Google Scholar]
  8. Hann I. M., Eden O. B., Barnes J., Pinkerton C. R. 'MACHO' chemotherapy for stage IV B cell lymphoma and B cell acute lymphoblastic leukaemia of childhood. United Kingdom Children's Cancer Study Group (UKCCSG). Br J Haematol. 1990 Nov;76(3):359–364. doi: 10.1111/j.1365-2141.1990.tb06368.x. [DOI] [PubMed] [Google Scholar]
  9. Hann I. M., Richards S. M., Eden O. B., Hill F. G. Analysis of the immunophenotype of children treated on the Medical Research Council United Kingdom Acute Lymphoblastic Leukaemia Trial XI (MRC UKALLXI). Medical Research Council Childhood Leukaemia Working Party. Leukemia. 1998 Aug;12(8):1249–1255. doi: 10.1038/sj.leu.2401093. [DOI] [PubMed] [Google Scholar]
  10. Levitt G. A., Stiller C. A., Chessells J. M. Prognosis of Down's syndrome with acute leukaemia. Arch Dis Child. 1990 Feb;65(2):212–216. doi: 10.1136/adc.65.2.212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lie S. O., Jonmundsson G., Mellander L., Siimes M. A., Yssing M., Gustafsson G. A population-based study of 272 children with acute myeloid leukaemia treated on two consecutive protocols with different intensity: best outcome in girls, infants, and children with Down's syndrome. Nordic Society of Paediatric Haematology and Oncology (NOPHO). Br J Haematol. 1996 Jul;94(1):82–88. doi: 10.1046/j.1365-2141.1996.d01-1761.x. [DOI] [PubMed] [Google Scholar]
  12. Meadows A. T., Kramer S., Hopson R., Lustbader E., Jarrett P., Evans A. E. Survival in childhood acute lymphocytic leukemia: effect of protocol and place of treatment. Cancer Invest. 1983;1(1):49–55. doi: 10.3109/07357908309040932. [DOI] [PubMed] [Google Scholar]
  13. Mott M. G., Chessells J. M., Willoughby M. L., Mann J. R., Morris-Jones P. H., Malpas J. S., Palmer M. K. Adjuvant low dose radiation in childhood T cell leukaemia/lymphoma (report from the United Kingdom Childrens' Cancer Study Group--UKCCSG). Br J Cancer. 1984 Oct;50(4):457–462. doi: 10.1038/bjc.1984.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mott M. G., Mann J. R., Stiller C. A. The United Kingdom Children's Cancer Study Group--the first 20 years of growth and development. Eur J Cancer. 1997 Aug;33(9):1448–1452. doi: 10.1016/s0959-8049(97)00250-5. [DOI] [PubMed] [Google Scholar]
  15. Pieters R., den Boer M. L., Durian M., Janka G., Schmiegelow K., Kaspers G. J., van Wering E. R., Veerman A. J. Relation between age, immunophenotype and in vitro drug resistance in 395 children with acute lymphoblastic leukemia--implications for treatment of infants. Leukemia. 1998 Sep;12(9):1344–1348. doi: 10.1038/sj.leu.2401129. [DOI] [PubMed] [Google Scholar]
  16. Richards S., Burrett J., Hann I., Chessells J., Hill F., Bailey C. Improved survival with early intensification: combined results from the Medical Research Council childhood ALL randomised trials, UKALL X and UKALL XI. Medical Research Council Working Party on Childhood Leukaemia. Leukemia. 1998 Jul;12(7):1031–1036. doi: 10.1038/sj.leu.2401065. [DOI] [PubMed] [Google Scholar]
  17. Schillinger J. A., Grosclaude P. C., Honjo S., Quinn M. J., Sloggett A., Coleman M. P. Survival after acute lymphocytic leukaemia: effects of socioeconomic status and geographic region. Arch Dis Child. 1999 Apr;80(4):311–317. doi: 10.1136/adc.80.4.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stiller C. A., Allen M. B., Eatock E. M. Childhood cancer in Britain: the National Registry of Childhood Tumours and incidence rates 1978-1987. Eur J Cancer. 1995 Nov;31A(12):2028–2034. doi: 10.1016/0959-8049(95)00428-9. [DOI] [PubMed] [Google Scholar]
  19. Stiller C. A., Draper G. J. Treatment centre size, entry to trials, and survival in acute lymphoblastic leukaemia. Arch Dis Child. 1989 May;64(5):657–661. doi: 10.1136/adc.64.5.657. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wheeler K., Chessells J. M., Bailey C. C., Richards S. M. Treatment related deaths during induction and in first remission in acute lymphoblastic leukaemia: MRC UKALL X. Arch Dis Child. 1996 Feb;74(2):101–107. doi: 10.1136/adc.74.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]

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