Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Abstract

Proportion cured is a potentially more informative cancer outcome measurement than 5-year survival. We present population-based estimates of cure for young patients diagnosed with acute lymphoblastic leukemia in Europe from 1982 to 2002. Thirty-five European cancer registries provided data. Survival was estimated by age, period of diagnosis and European region, and used as input for parametric cure models, which assume cured patients have the same mortality as the general population. For acute lymphoblastic leukemia diagnosed in 1-14 year olds in 2000-2002, over 77% were estimated cured. The proportion cured improved significantly over the study period: an impressive 26-58% in infants (up to 1 year), 70-90% in 1-4 year olds, 63-86% in 5-9 year olds, 52-77% in 10-14 year olds, and 44-50% in 15-24 year olds. Regional variations in proportion cured reduced over time for 1-14 year-olds, but persisted in infants and 15-24 year olds. Five-year survival was always slightly higher than proportion cured. Considerable proportions of young patients were estimated cured of acute lymphoblastic leukemia. Nevertheless, a small excess risk of death persisted beyond five years after diagnosis when patients remained at risk for late treatment effects, late relapses and second primaries.

Figure 1.

(A) Age-standardized cumulative survival in children (age 0–14 years) of both sexes by diagnosis period (3-year periods from 1982 to 2002). (B) Cumulative relative survival in adolescents and young adults (15–24 years) by 3-year periods from 1988 to 2002. Vertical bars indicate 95% confidence intervals.

Figure 2.

Annual survival probabilities for children (age 0–14 years) diagnosed with acute lymphoblastic leukemia by diagnosis period (3-year periods from 1982 to 1990).

Figure 3.

Cure model-based estimates of proportion of infants, children (three age classes), adolescents, and young adults cured of acute lymphoblastic leukemia by diagnosis period (3-year periods from 1982 to 2002) in Europe. Vertical bars indicate 95% confidence intervals.

Figure 4.

Estimated cured proportions for infants, children (three age classes) and adolescents plus young adults, diagnosed with acute lymphoblastic leukemia, according to European region and diagnosis period (3-year periods from 1982 to 2002). Vertical bars indicate 95% confidence intervals.