Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group

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. In total, 21,626 persons age 0 to 22...

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Veröffentlicht in:	Journal of clinical oncology Jg. 30; H. 14; S. 1663
Hauptverfasser:	Hunger, Stephen P, Lu, Xiaomin, Devidas, Meenakshi, Camitta, Bruce M, Gaynon, Paul S, Winick, Naomi J, Reaman, Gregory H, Carroll, William L
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 10.05.2012
Schlagworte:	Adolescent Age Factors Antineoplastic Combined Chemotherapy Protocols - administration & dosage 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 - diagnosis Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Prognosis Proportional Hazards Models Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Survival Analysis Time Factors Treatment Outcome United States United States
ISSN:	1527-7755, 1527-7755
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Abstract	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. 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. 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. 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.
AbstractList	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.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.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.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.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.RESULTSFive-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.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.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. 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. 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. 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. 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	Winick, Naomi J Devidas, Meenakshi Camitta, Bruce M Hunger, Stephen P Reaman, Gregory H Lu, Xiaomin Gaynon, Paul S Carroll, William L
Author_xml	– sequence: 1 givenname: Stephen P surname: Hunger fullname: Hunger, Stephen P email: stephen.hunger@childrenscolorado.org organization: University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA. stephen.hunger@childrenscolorado.org – sequence: 2 givenname: Xiaomin surname: Lu fullname: Lu, Xiaomin – sequence: 3 givenname: Meenakshi surname: Devidas fullname: Devidas, Meenakshi – sequence: 4 givenname: Bruce M surname: Camitta fullname: Camitta, Bruce M – sequence: 5 givenname: Paul S surname: Gaynon fullname: Gaynon, Paul S – sequence: 6 givenname: Naomi J surname: Winick fullname: Winick, Naomi J – sequence: 7 givenname: Gregory H surname: Reaman fullname: Reaman, Gregory H – sequence: 8 givenname: William L surname: Carroll fullname: Carroll, William L
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/22412151$$D View this record in MEDLINE/PubMed
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References_xml	– reference: 19641190 - Blood. 2009 Sep 24;114(13):2688-98 – reference: 20010620 - Leukemia. 2010 Feb;24(2):371-82 – reference: 20010621 - Leukemia. 2010 Feb;24(2):406-18 – reference: 21562038 - Blood. 2011 Jul 14;118(2):243-51 – reference: 1637970 - Biometrics. 1992 Jun;48(2):411-25 – reference: 10673523 - J Clin Oncol. 2000 Feb;18(4):813-23 – reference: 20016537 - Leukemia. 2010 Feb;24(2):320-34 – reference: 19880498 - Blood. 2010 Feb 18;115(7):1394-405 – reference: 8558195 - J Clin Oncol. 1996 Jan;14(1):18-24 – reference: 9329463 - J Pediatr Hematol Oncol. 1997 Sep-Oct;19(5):423-7 – reference: 20139093 - Blood. 2010 Jul 1;115(26):5312-21 – reference: 19129520 - N Engl J Med. 2009 Jan 29;360(5):470-80 – reference: 19747876 - Lancet Oncol. 2009 Oct;10(10):957-66 – reference: 20016528 - Leukemia. 2010 Feb;24(2):309-19 – reference: 19553647 - N Engl J Med. 2009 Jun 25;360(26):2730-41 – reference: 14559954 - JAMA. 2003 Oct 15;290(15):2008-14 – reference: 20016536 - Leukemia. 2010 Feb;24(2):255-64 – reference: 12610173 - J Clin Oncol. 2003 Mar 1;21(5):774-80 – reference: 17658395 - Lancet. 2007 Jul 21;370(9583):240-50 – reference: 18502832 - Blood. 2008 Sep 1;112(5):1646-54 – reference: 19470474 - Proc Natl Acad Sci U S A. 2009 Jun 9;106(23):9414-8 – reference: 19838194 - Nat Genet. 2009 Nov;41(11):1243-6 – reference: 21135279 - J Clin Oncol. 2011 Jan 10;29(2):214-22 – reference: 9401854 - J Adolesc Health. 1997 Dec;21(6):366-73 – reference: 20154213 - Blood. 2010 Apr 22;115(16):3206-14 – reference: 18780868 - J Natl Cancer Inst. 2008 Sep 17;100(18):1301-9 – reference: 20699438 - Blood. 2010 Dec 2;116(23):4874-84 – reference: 19805687 - J Clin Oncol. 2009 Nov 1;27(31):5175-81 – reference: 18388178 - Blood. 2008 Jun 15;111(12):5477-85 – reference: 18818707 - Leukemia. 2008 Dec;22(12):2142-50 – reference: 20010625 - Leukemia. 2010 Feb;24(2):265-84 – reference: 18860765 - N Engl J Med. 1948 Jun 3;238(23):787-93 – reference: 19684603 - Nat Genet. 2009 Sep;41(9):1001-5 – reference: 19138562 - Lancet Oncol. 2009 Feb;10(2):125-34 – reference: 23032621 - J Clin Oncol. 2012 Nov 10;30(32):4037-8; author reply 4038-9 – reference: 831755 - Br J Cancer. 1977 Jan;35(1):1-39 – reference: 17003380 - Blood. 2007 Feb 1;109(3):926-35 – reference: 20016527 - Leukemia. 2010 Feb;24(2):355-70 – reference: 18974371 - Blood. 2009 Feb 12;113(7):1408-11 – reference: 19805689 - J Clin Oncol. 2009 Nov 1;27(31):5189-94 – reference: 18039957 - Blood. 2008 Mar 1;111(5):2548-55 – reference: 19176441 - JAMA. 2009 Jan 28;301(4):393-403 – reference: 20592248 - Blood. 2010 Oct 14;116(15):2644-50 – reference: 20016531 - Leukemia. 2010 Feb;24(2):285-97
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Snippet	To examine population-based improvements in survival and the impact of clinical covariates on outcome among children and adolescents with acute lymphoblastic...
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SubjectTerms	Adolescent Age Factors Antineoplastic Combined Chemotherapy Protocols - administration & dosage 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 - diagnosis Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Prognosis Proportional Hazards Models Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Survival Analysis Time Factors Treatment Outcome United States
Title	Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group
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