Journal of the National Cancer Institute Advance Access originally published online on September 9, 2008
JNCI Journal of the National Cancer Institute 2008 100(18):1301-1309; doi:10.1093/jnci/djn276
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© The Author 2008. Published by Oxford University Press.
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Trends in 5- and 10-year Survival After Diagnosis with Childhood Hematologic Malignancies in the United States, 1990–2004
Affiliations of authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (DP, AG, HB); Weill Cornell Medical Center, New York (DP)
Correspondence to: Hermann Brenner, MD, MPH, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Strasse 20, D-69115 Heidelberg, Germany (e-mail: h.brenner{at}dkfz-heidelberg.de).
Background: Advances in the treatment of childhood hematologic malignancies have led to improvements in survival for several of these conditions during the past few decades, but most population-based survival data available to date refer only to patients diagnosed up to the mid-1990s.
Methods: We used period analysis to assess trends in 5- and 10-year survival in US patients younger than 15 years of age at diagnosis with four hematologic malignancies—acute lymphoblastic leukemia, acute non-lymphoblastic leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma—over three recent 5-year intervals, 1990–1994, 1995–1999, and 2000–2004, using data on a total of 6957 patients from the Surveillance, Epidemiology, and End Results database. Expected survival for 2005–2009 was estimated by modeling from trends in the preceding intervals.
Results: Major improvements in 5- and 10-year relative survival between 1990–1994 and 2000–2004 were seen for acute lymphoblastic leukemia (from 80.2% to 87.5% and from 73.4% to 83.8%, respectively), acute non-lymphoblastic leukemia (from 41.9% to 59.9% and from 38.7% to 59.1%, respectively), and non-Hodgkin lymphoma (from 76.6% to 87.7% and from 73.0% to 86.9%, respectively). For those diagnosed with Hodgkin lymphoma, 5- and 10-year survival rates for the 1990–1994 period were 96.1% and 94.4%, respectively, and these rates did not change substantially in the later time periods. Projected 10-year survival rates for children diagnosed in the 2005–2009 period were 88.0% for acute lymphoblastic leukemia, 63.9% for acute non-lymphoblastic leukemia, 90.6% for non-Hodgkin lymphoma, and 94.3% for Hodgkin lymphoma.
Conclusions: Application of period analysis to a population-based study of childhood hematologic malignancies reveals ongoing increases in survival for three of the four common childhood hematologic malignancies.
| Context and Caveats Prior knowledge The available estimates of long-term survival for survivors of childhood hematologic malignancies are based on data from children who were diagnosed in the early and mid-1990s and thus may not reflect the possible impact of recent advances in treatment on survival. Study design A period analysis of 5- and 10-year survival probabilities for US children diagnosed before the age of 15 years with acute lymphoblastic leukemia, acute non-lymphoblastic leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma diagnosed during three recent 5-year intervals—1990–1994, 1995–1999, and 2000–2004—based on Surveillance, Epidemiology, and End Results data for 6957 patients. Contribution Both 5- and 10-year survival of children diagnosed with acute lymphoblastic leukemia, acute non-lymphoblastic leukemia, and non-Hodgkin lymphoma have improved from the 1990–1994 period to the 2000–2004 period. The 5- and 10-year survival rates for children diagnosed with Hodgkin lymphoma during the 1990–1994 period (96.1% and 94.4%, respectively) did not change substantially in the later time periods. Implications Improvements in survival in childhood hematologic malignancies are most likely attributable to changes in how these diseases are treated. The timely disclosure of these improvements may encourage compliance with available and effective therapies. Limitations The 95% confidence intervals for some survival estimates were wide. Even with period analysis, the estimates of survival for the 2000–2004 period tend to underestimate the survival of newly diagnosed patients. From the Editors
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Manuscript received February 19, 2008; revised June 16, 2008; accepted August 7, 2008.
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J Natl Cancer Inst 2008 100: 1271-1273.
J Natl Cancer Inst 2008 100: 1269.
J Natl Cancer Inst 2008 100: 1269.
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