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Long-term survival after childhood acute lymphoblastic leukaemia: Population-based trends in cure and relapse by clinical characteristics

Lookup NU author(s): Dr Lucy Chilton, Professor Anthony Moorman, Richard Feltbower

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Abstract

© 2018 John Wiley & Sons Ltd. 'Cure models' offer additional information to traditional epidemiological approaches to assess survival for cancer patients by simultaneously estimating the proportion cured and the survival of those 'uncured'. The proportion cured is a summary of long-term survival while the median survival time of the uncured provides important information on those who are not long-term survivors. Population-based trends in the cure proportion and survival of the uncured for childhood acute lymphoblastic leukaemia (ALL) by clinical prognostic risk factors were estimated using flexible parametric cure models, based on overall survival and event-free survival. Children aged 1-17 years diagnosed between 1990 and 2011 in Yorkshire, UK, were included (n = 492). The percentage cured increased from 77% (95% confidence interval 70-84%) in 1990-1997 to 89% (84-93%) in 2003-2011, while the median survival time of the uncured decreased from 3·2 years (2·2-4·1 years) to 0·7 years (0-1·5 years). Models based on event-free survival showed a similar trend. The 5-year cumulative incidence of relapse substantially decreased from 35% in 1990-97 to 9% in 2003-2011. These results show selective improvement in survival between 1990 and 2011 with a significant reduction in the risk of relapse alongside a reduced absolute duration of survival for those destined to be uncured.


Publication metadata

Author(s): Smith L, Glaser AW, Kinsey SE, Greenwood DC, Chilton L, Moorman AV, Feltbower RG

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2018

Volume: 182

Issue: 6

Pages: 851-858

Print publication date: 01/09/2018

Online publication date: 29/05/2018

Acceptance date: 30/04/2018

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: Wiley-Blackwell

URL: https://doi.org/10.1111/bjh.15424

DOI: 10.1111/bjh.15424


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