Danny R Youlden1,2, Sumit Gupta3,4, A Lindsay Frazier5, Andrew S Moore6,7,8, Peter D Baade1,2,9, Patricia C Valery10, Adèle C Green10,11, Joanne F Aitken1,2,12,13. 1. Cancer Council Queensland, Brisbane, Queensland, Australia. 2. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia. 3. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada. 4. Faculty of Medicine, University of Toronto, Toronto, Canada. 5. Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. 6. The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia. 7. Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia. 8. UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia. 9. School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia. 10. QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. 11. CRUK Manchester Institute and Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom. 12. Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia. 13. School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Information on stage at diagnosis for childhood blood cancers is essential for surveillance but is not available on a population basis in most countries. Our aim was to apply the internationally endorsed Toronto Paediatric Cancer Stage Guidelines to children (<15 years) with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma (HL), or non-Hodgkin lymphoma (NHL) and to assess differences in survival by stage at diagnosis. PROCEDURE: Stage was defined by extent of involvement of the central nervous system (CNS) for ALL and AML and using the Ann Arbor and St Jude-Murphy systems for HL and NHL, respectively. The study cohort was drawn from the population-based Australian Childhood Cancer Registry, consisting of children diagnosed with one of these four blood cancers between 2006 and 2014 with follow-up to 2015. Five-year observed survival was estimated from the Kaplan-Meier method. RESULTS: Stage was assigned to 2201 of 2351 eligible patients (94%), ranging from 85% for AML to 95% for ALL, HL, and NHL. Survival following ALL varied from 94% (95% CI = 93%-95%) for CNS1 disease to 89% (95% CI = 79%-94%) for CNS2 (P = 0.07), whereas for AML there was essentially no difference in survival between CNS- (77%) and CNS+ disease (78%; P = 0.94). Nearly all children with HL survived for five years. There was a trend (P = 0.04) toward worsening survival with higher stage for NHL. CONCLUSIONS: These results provide the first population-wide picture of the distribution and outcomes for childhood blood cancers in Australia by extent of disease at diagnosis and provide a baseline for future comparisons.
BACKGROUND: Information on stage at diagnosis for childhood blood cancers is essential for surveillance but is not available on a population basis in most countries. Our aim was to apply the internationally endorsed Toronto Paediatric Cancer Stage Guidelines to children (<15 years) with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma (HL), or non-Hodgkin lymphoma (NHL) and to assess differences in survival by stage at diagnosis. PROCEDURE: Stage was defined by extent of involvement of the central nervous system (CNS) for ALL and AML and using the Ann Arbor and St Jude-Murphy systems for HL and NHL, respectively. The study cohort was drawn from the population-based Australian Childhood Cancer Registry, consisting of children diagnosed with one of these four blood cancers between 2006 and 2014 with follow-up to 2015. Five-year observed survival was estimated from the Kaplan-Meier method. RESULTS: Stage was assigned to 2201 of 2351 eligible patients (94%), ranging from 85% for AML to 95% for ALL, HL, and NHL. Survival following ALL varied from 94% (95% CI = 93%-95%) for CNS1 disease to 89% (95% CI = 79%-94%) for CNS2 (P = 0.07), whereas for AML there was essentially no difference in survival between CNS- (77%) and CNS+ disease (78%; P = 0.94). Nearly all children with HL survived for five years. There was a trend (P = 0.04) toward worsening survival with higher stage for NHL. CONCLUSIONS: These results provide the first population-wide picture of the distribution and outcomes for childhood blood cancers in Australia by extent of disease at diagnosis and provide a baseline for future comparisons.