Survival Inequalities in Childhood Leukemia Remain Large Worldwide, Despite Progress

While global inequalities for survival of childhood leukemia have narrowed, the gap remains wide for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), according to a study published in The Lancet Haematology. In some countries, the 5-year survival rate is nearly twice as high as in others for children diagnosed in 2005-2009.

The researchers analyzed data from nearly 90,000 children from 53 countries. They compared 5-year survival during 1995-1999 with 5-year survival in 2005-2009. The improvements in diagnostic techniques and treatments have contributed to the narrowing inequality gap, but some countries have had difficulty accessing the techniques and treatments due to shortages.

“There is room for improvement in the management of childhood leukemia in many countries,” lead author Audrey Bonaventure, MD, MSc, PhD, London School of Hygiene and Tropical Medicine, said in a statement. “These findings show the extent of worldwide inequalities in access to optimal healthcare for children with cancer.”

In 1995-1999, the 5-year survival for all lymphoid leukemias ranged from 10.6% in China to 86.8% in Austria. In 2005-2009, the survival rate ranged from 52.4% in Cali, Colombia, to 91.6% in Germany.

Survival for ALL was higher than survival for AML, even though there was significant progress in 5-year survival for AML. In 1995-1999, survival for AML ranged from just 4% in China to 72% in Sweden, and in 2005-2009, survival ranged from 33% in Bulgaria to 78% in Germany.

The high survival rates in Germany and Austria were thought to be attributable to the fact that providers tightly adhere to treatment protocols.

The study was limited by the fact that some countries had a small number of patients and limited data collection. For instance, in Tunisia, more than 75% of the records were ineligible because of incomplete data. And in some low- and middle-income countries the data was so sparse that the researchers were limited in being able to interpret survival trends.

“Interventions that have been proven to improve outcomes in childhood malignancy include enrollment in clinical trials, international collaboration and treatment guidelines,” the authors concluded. “Wider implementation of these initiatives, together with mobilization of additional resources, especially in poorer countries, would be likely to improve the delivery of effective treatments, and to reduce worldwide inequalities in survival.”