Patterns of care and survival for children with acute lymphoblastic leukaemia diagnosed between 1980 and 1994
C A Stiller, E M Eatock
Childhood Cancer
Research Group, Department of Paediatrics, University of Oxford, 57 Woodstock Road, Oxford OX2 6HJ, UK
Correspondence to: Mr Stiller.
Accepted 19 May 1999
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.
PATIENTSFrom 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
MEASURESActuarial survival rates.
RESULTSBetween
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.
CONCLUSIONSSurvival
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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Key messages
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Keywords: leukaemia; survival; referral patterns; clinical trials
© 1999 by Archives of Disease in Childhood
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