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Eur J Cancer. 2016 Nov;67:183-190. doi: 10.1016/j.ejca.2016.08.011. Epub 2016 Sep 24.

Survival trends in childhood chronic myeloid leukaemia in Southern-Eastern Europe and the United States of America.

Author information

1
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 11527, Greece.
2
Department of Pediatric Hematology-Oncology, "Pan & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, 11527, Athens, Greece.
3
National Cancer Registry of Ukraine, National Institute of Cancer, Lomonosova str, 33/43, Kyiv, 03022, Ukraine.
4
Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Subregistry of Belarus, Lesnoe-2, 223040, Minsk Region, Belarus.
5
Bulgarian National Cancer Registry, National Oncology Hospital, 6, Plovdivsko Pole Street, Sofia, 1756, Bulgaria.
6
Institute of Public Health of Serbia, Dr Subotica 5, Belgrade, 11000, Serbia.
7
Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Zubeyde Hanim Caddesi No:100, Karsiyaka, Izmir, 35067, Turkey.
8
North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Rua António Bernardino da Almeida, Porto, 4200-072, Portugal.
9
Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, Zagreb, 10000, Croatia.
10
Cancer Registry of Republic of Slovenia, Institute of Oncology, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia.
11
Central Region Cancer Registry of Portugal (ROR-Centro), Portuguese Oncology Institute of Coimbra, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal.
12
Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, 1 Prodromou Str & 17 Chilonos Str, Nicosia, 1448, Cyprus.
13
Malta National Cancer Registry, Department of Health Information and Research, 95, Guardamangia Hill, Guardamangia, MSD 08, Malta.
14
Regional Cancer Registry of Iasio, National Institute of Public Health, 14 Victor Babes Street 700465, Iasi, Romania.
15
Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Republicii Str no. 34-36, Cluj Napoca, 400015, Romania.
16
Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece.
17
Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Arsinois 23, Heraklion Crete, 71303, Greece.
18
Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece.
19
2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
20
Department of Pediatric Hematology and Oncology, Hippokration Hospital, Konstantinoupoleos Str 49, Thessaloniki, 54642, Greece.
21
Stem Cell Transplantion Unit, Aghia Sophia Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece.
22
Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rua Andre Cavalcanti, 37, Rio de Janeiro, 20230-130, Brazil.
23
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.H., Chan School of Public Health, Boston, MA, USA; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Kirkeveien 166, Frederik Holsts hus, Oslo, 0450, Norway.
24
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 11527, Greece. Electronic address: epetrid@med.uoa.gr.

Abstract

AIM:

To assess trends in survival and geographic disparities among children (0-14 years) with chronic myeloid leukaemia (CML) before and after the introduction of molecular therapy, namely tyrosine kinase inhibitors (TKIs) in Southern-Eastern European (SEE) countries and the USA.

METHODS:

We calculated survival among children with CML, acute lymphoblastic (ALL) and acute myeloid leukaemia (AML) in 14 SEE (1990-2014) cancer registries and the U.S. Surveillance, Epidemiology and End Results Program (SEER, 1990-2012). We used Kaplan-Meier curves and multivariate Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS:

Among 369 CML cases, substantial improvements were noted in 2-year survival during the post-TKI (range: 81-89%) compared to pre-TKI period (49-66%; HR: 0.37, 95% CI: 0.23-0.60). Risk of death was three times higher for <5-year-old children versus those aged 10-14 years (HR: 3.03, 95% CI: 1.85-4.94) and 56% higher for those living in SEE versus SEER (HR: 1.56, 95% CI: 1.01-2.42). Regardless of geographic area and period of TKI administration, however, age seems to be a significant determinant of CML prognosis (pre-TKI period, HR0-4y: 2.71, 95% CI: 1.53-4.79; post-TKI period, HR0-4y: 3.38, 95% CI: 1.29-8.85). Noticeably, post-TKI survival in CML overall approximates that for ALL, whereas therapeutic advancements for AML remain modest.

CONCLUSION:

Registry data show that introduction of molecular therapies coincides with revolutionised therapeutic outcomes in childhood CML entailing dramatically improved survival which is now similar to that in ALL. Given that age disparities in survival remain substantial, offering optimal therapy to entire populations is an urgent priority.

KEYWORDS:

Cancer registration; Child; Chronic myeloid leukaemia; Inequalities; Survival; Tyrosine kinase inhibitors

PMID:
27677054
DOI:
10.1016/j.ejca.2016.08.011
[Indexed for MEDLINE]

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