Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

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Abstract

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group. Funding: Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, US National Cancer Institute, and the American Cancer Society.

Original languageEnglish
Pages (from-to)409-431
Number of pages23
JournalThe Lancet Child and Adolescent Health
Volume6
Issue number6
DOIs
StatePublished - Jun 2022

Bibliographical note

Funding Information:
This study was funded by Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, the US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, the US National Cancer Institute, and the American Cancer Society. The interpretation of the findings in this report, and the opinions, conclusions, and recommendations are those of the authors and do not necessarily reflect the views or official position of the British Columbia Cancer Agency or Cancer Care Ontario (Canada); the Centers for Disease Control and Prevention (USA), the National Cancer Institute (USA), the Maryland Cancer Registry (USA), the New Hampshire Department of Health and Human Services (USA), the New York City Department of Health and Mental Hygiene (USA), the Ohio Department of Health (USA), the Pennsylvania Department of Health or West Virginia Cancer Registry (USA), the Health Directorate of the Australian Capital Territory, or the Institut National du Cancer (France). We thank Keiu Paapsi (Estonia Cancer registry) for her thoughtful comments and Tahera Razavi for preliminary data management.

Funding Information:
DWH received a grant for joint co-production of cancer intelligence analysis outputs from Macmillan Cancer Support, consultancy fees from Pfizer for research carried out by Swansea University, Wales, UK, in relation to value-based health care, and unsolicited small gifts from Moondance Cancer Initiative for philanthropic work. All other authors declare no competing interests.

Funding Information:
This study was funded by Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, the US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, the US National Cancer Institute, and the American Cancer Society. The interpretation of the findings in this report, and the opinions, conclusions, and recommendations are those of the authors and do not necessarily reflect the views or official position of the British Columbia Cancer Agency or Cancer Care Ontario (Canada); the Centers for Disease Control and Prevention (USA), the National Cancer Institute (USA), the Maryland Cancer Registry (USA), the New Hampshire Department of Health and Human Services (USA), the New York City Department of Health and Mental Hygiene (USA), the Ohio Department of Health (USA), the Pennsylvania Department of Health or West Virginia Cancer Registry (USA), the Health Directorate of the Australian Capital Territory, or the Institut National du Cancer (France). We thank Keiu Paapsi (Estonia Cancer registry) for her thoughtful comments and Tahera Razavi for preliminary data management. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology

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