Trends in survival of leukemia among children, adolescents, and young adults: A population‐based study in Osaka, Japan

• Published in: Cancer science Vol. 112; no. 3; pp. 1150 - 1160
• Main Authors: Nakata, Kayo, Okawa, Sumiyo, Fuji, Shigeo, Sato, Akira, Morishima, Toshitaka, Tada, Yuma, Inoue, Masami, Hara, Junichi, Kawa, Keisei, Miyashiro, Isao
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.03.2021; John Wiley and Sons Inc
• Subjects: Acute lymphoblastic leukemia; Acute myeloid leukemia; Adolescent; Adolescents; adolescents and young adults; Adult; Age; Age Factors; Cancer Care Facilities - statistics & numerical data; Cancer therapies; Chemotherapy; Child; Child, Preschool; Children; Chronic myeloid leukemia; Confidence intervals; epidemiology; Female; Follow-Up Studies; Hospitals; Humans; Infant; Infant, Newborn; Japan - epidemiology; Kaplan-Meier Estimate; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Lymphatic leukemia; Male; Medical prognosis; Molecular Targeted Therapy - methods; Molecular Targeted Therapy - statistics & numerical data; Morphology; Myeloid leukemia; Original; Patients; Pediatrics; Population; Population studies; Population-based studies; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prognosis; Proportional Hazards Models; Protein Kinase Inhibitors - therapeutic use; Protein-tyrosine kinase; Registries - statistics & numerical data; Risk Factors; Sex Factors; Stem cells; Survival; Teenagers; Trends; Young Adult; Young adults; Japan; United States > US; Osaka Japan; epidemiology; leukemia; adolescents and young adults; children; survival
• ISSN: 1347-9032; 1349-7006; 1349-7006
• DOI: 10.1111/cas.14808

This study focused on children as well as adolescents and young adults (AYAs) and aimed to examine trends in survival of leukemia over time using population‐based cancer registry data from Osaka, Japan. The study subjects comprised 2254 children (0‐14 years) and 2,905 AYAs (15‐39 years) who were diagnosed with leukemia during 1975‐2011. Leukemia was divided into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and other leukemias. We analyzed 5‐year overall survival probability (5y‐OS), using the Kaplan‐Meier method and expressed time trends using the joinpoint regression model. For recently diagnosed (2006‐2011) patients, a Cox proportional hazards model was applied to determine predictors of 5y‐OS, using age group, gender, and treatment hospital as covariates. Over the 37‐year period, 5y‐OS greatly improved among both children and AYAs, for each leukemia type. Among AYAs, 5y‐OS of ALL improved, especially after 2000 (65% in 2006‐2011), when the pediatric regimen was introduced but was still lower than that among children (87% in 2006‐2011, P < .001). Survival improvement was most remarkable in CML, and its 5y‐OS was over 90% among both children and AYAs after the introduction of molecularly targeted therapy with tyrosine kinase inhibitors. Among patients with recently diagnosed AML, the risk of death was significantly higher for patients treated at nondesignated hospitals than those treated at designated cancer care hospitals. The changes in survival improvement coincided with the introduction of treatment regimens or molecularly targeted therapies. Patient centralization might be one option which would improve survival. Survival of each type of leukemia in children, adolescents, and young adults has improved dramatically over the past 30 years.