Increased survival disparities among children and adolescents & young adults with acute myeloid leukemia: A Dutch population-based study

Maya Schulpen, Bianca F. Goemans, Gertjan J.L. Kaspers, Marc H.G.P. Raaijmakers, C. Michel Zwaan, Henrike E. Karim-Kos*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
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Abstract

For many cancers, adolescents and young adults (AYAs) have a poorer prognosis than pediatric patients. Our study evaluates survival outcomes of children (0-17 years) and AYAs (18-39 years) diagnosed with acute myeloid leukemia (AML) in the Netherlands between 1990 and 2015 (N = 2058) utilizing the population-based Netherlands Cancer Registry, which includes information on therapy and site of primary treatment. Five- and 10-year relative (disease-specific) survival were estimated for all patients, children and AYAs. Multivariable analyses were performed using generalized linear models (excess mortality) and logistic regression (early mortality). AYAs with AML had a substantially lower 5- and 10-year relative survival than children (5-year: 43% vs 58%; 10-year: 37% vs 51%). The gap in 5-year relative survival was largest (nearly 20 percent-points) in 2010 to 2015, despite survival improvements over time across all ages. The multivariable-adjusted excess risk of dying was 60% higher in AYAs (95% CI: 37%-86%). Early mortality (death within 30 days of diagnosis) declined over time, and did not differ between children and AYAs. In conclusion, AYAs diagnosed with AML in the Netherlands had a worse prognosis than pediatric patients. The survival gap seemed most pronounced in recent years, suggesting that improvements in care resulting in better outcome for children have not led to equal benefits for AYAs.

Original languageEnglish
Pages (from-to)1101-1112
Number of pages12
JournalInternational Journal of Cancer
Volume150
Issue number7
Early online date16 Dec 2021
DOIs
Publication statusPublished - 1 Apr 2022

Bibliographical note

Funding Information:
The authors would like to thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the NCR. Moreover, DCOG and HOVON/SAKK are acknowledged for the design of new treatment protocols and the recruitment of patients into AML trials. In addition, all oncologists who have treated young AML patients and have entered their data are thanked. The authors also thank Dr. Avinash Dinmohamed (IKNL) for sharing his knowledge on statistical analyses, the NCR data and registration practices. The study was performed with financial support from Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. The funder had no role in the study design, data collection, analyses and interpretation of the results, nor in the writing of this manuscript.

Funding Information:
The authors would like to thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the NCR. Moreover, DCOG and HOVON/SAKK are acknowledged for the design of new treatment protocols and the recruitment of patients into AML trials. In addition, all oncologists who have treated young AML patients and have entered their data are thanked. The authors also thank Dr. Avinash Dinmohamed (IKNL) for sharing his knowledge on statistical analyses, the NCR data and registration practices. The study was performed with financial support from Erasmus MC‐Sophia Children's Hospital, Rotterdam, the Netherlands. The funder had no role in the study design, data collection, analyses and interpretation of the results, nor in the writing of this manuscript.

Publisher Copyright:
© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

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