1: Chin Med J (Engl) 1999 Jul;112(7):615-9 Related Articles, Books, LinkOut

Very long survival in pediatric cancer between 1944 and 1993.

Zhao G, Boysen CD, Brown EF, Hassanein KM, Holmes FF, Holmes GE.

Henan Institute of Medical Sciences, Henan Medical University, Henan 450052, China.

OBJECTIVE: To identify factors associated with very long survival among all cancer cases diagnosed at age 19 years or younger registered by the Cancer Data Service at the University of Kansas Medical Center in Kansas City, Kansas, U.S.A. in the 40-year period between 1944 and 1983, with follow-up to 1993. METHODS: There were 2720 pediatric patients with 2750 cancers who were studied. Forty-four types of cancer were grouped into 11 diagnostic categories. Diagnosis years spanned four eras: 1944-1953, 1954-1963, 1964-1973, and 1974-1983. Cases were compared using specific characteristics and were divided into short-term and long-term survivors with the division generously set at seven years. The proportions of the long-term survivors were compared by specific characteristics. RESULTS: Among the diagnostic categories, leukemias were the most common (29.8%), followed by CNS tumors (15.2%), and Hodgkin's disease (9.0%). Male to female ratio was 4:3; average age at diagnosis was 8.83 +/- 6.08 years. Long-term survivors totaled 1148 (41.7%). Prognosis was better in cases diagnosed in earlier stages and in later eras. Proportion of long-term survivors increased from 18.7% in era I to 52.6% in era IV. Improvement of survival was statistically significant in most diagnostic categories. CONCLUSIONS: This study shows continuing improvement of survival during four consecutive eras for childhood and adolescent cancer. Early diagnosis was associated with better survival. Unstaged cases decreased over time reflecting progress in diagnostic techniques. Many patients died before seven years after diagnosis. Those who survived more than seven years had excellent survival. Pediatricians can expect to participate in the care of these patients long after the original dianosis and treatment.

PMID: 11601255 [PubMed - indexed for MEDLINE]

1: Am J Hematol 2001 Oct;68(2):91-8 Related Articles, Books, LinkOut

TEL/AML1 rearrangement and the prognostic significance in childhood acute lymphoblastic leukemia in Hong Kong.

Tsang KS, Li CK, Chik KW, Shing MM, Tsoi WC, Ng MH, Lau TT, Leung Y, Yuen PM.

Hematology and Bone Marrow Transplantation Division, Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.

The TEL/AML1 rearrangement has been implicated as an independent good prognostic factor in pediatric acute lymphoblastic leukemia (ALL). We examined TEL/AML1 using nested reverse-transcription polymerase chain reaction (RT-PCR) and correlated TEL/AML1 with cytogenetics and immunophenotypes in 75 consecutively analyzed Chinese children with ALL in Hong Kong. TEL/AML1 was detected in 17.9% (12/67) B-lineage ALL at diagnosis but not in 8 T-ALL children or in 34 adults with ALL. E2A/PBX1, MLL/AF4, and BCR/ABL were not found in TEL/AML1+ patients. Coexpression of cross-lineage antigens was associated with TEL/AML1 gene fusion (p = 0.032), with CD13 in 80% (4/5) TEL/AML1+ cohort. Chromosomal abnormalities were demonstrated in 50% of the TEL/AML1+ ALL; however, a cryptic t(12;21) was not detected in these cases. Hyperdiploidy of 47-48 chromosomes was encountered in 25%. Deletion of 12p resulting in the loss of the normal allele of TEL and nonspecific del(6q) were noted in 8% (1/12) and 25% (3/12) of the TEL/AML1+ children, respectively. Rapid clearance of TEL/AML1 was noted in 50% of the patients on completion of the induction therapy; however, 16.7% (2/12) TEL/AML1+ ALL relapsed at a mean of 48.6 months from diagnosis (25 months off-therapy). The incidence of relapses of TEL/AML1+ ALL was comparable to that at diagnosis in B-lineage ALL (14.3% [2/14] vs. 17.9% [12/67], p > 0.05). The relapse rate in TEL/AML1+ ALL was similar to that of TEL/AML1- ALL (16.7% [2/12] vs. 20.6% [13/63], p > 0.05). The duration of first complete remission in TEL/AML1+ ALL was significantly longer as compared to TEL/AML1- ALL (mean [range] in month: 48.6 [47.2 - 50] vs 14.6 [2.9 - 42.3], p < 0.0001). Irrespective of TEL/AML1 rearrangement, the probabilities of the five-year overall survival and the event-free survival of patients were comparable (overall survival: 100% vs. 72.3%, p = 0.166 and event-free survival: 60% vs. 56.2%, p = 0.343). Our data would not suggest a less aggressive treatment regimen for TEL/AML1+ ALL. Copyright 2001 Wiley-Liss, Inc.

PMID: 11559948 [PubMed - indexed for MEDLINE]

1: Med Pediatr Oncol 1999 Feb;32(2):117-23 Related Articles, Books, LinkOut

Outcomes and prognostic factors of Chinese children with acute lymphoblastic leukemia in Hong Kong: preliminary results.

Shing MM, Li CK, Chik KW, Lam TK, Lai HD, Ng MH, Cheung AY, Yuen PM.

Lady Pao Children's Cancer Centre, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT. mk-shing@cuhk.edu.hk.hk

BACKGROUND: The Chinese population is the biggest ethnic group in the world. However, there are few reports on the treatment outcome of childhood acute lymphoblastic leukaemia (ALL) among the Chinese population. PROCEDURE: Sixty-five children with ALL were treated with a modified protocol of the Medical Research Council United Kingdom Acute Lymphoblastic Leukaemia protocol X(MRC UKALL X) at the Prince of Wales Hospital, Hong Kong. Most patients were ethnic Chinese. They were divided into groups A and B, depending on whether their presenting leucocyte count being was less or greater than 50 x 10(9)/l, respectively. Group A patients of received induction, early intensification (week 5), cranial irradiation, and maintenance for 3 years. Group B patients received an additional late intensification (week 20). RESULTS: The median follow-up duration was 6.8 years(range: 3.4-10.1 years). The event-free and overall survival rates of all patients at 7 years were 66% (confidence interval [CI] 53-76) and 75% (CI 63-84), respectively. The event-free survival rates of groups A and B at 7 years were 67% (CI 52-79) and 60% (CI 32-80), respectively (P= 0.39). The overall survival rates of groups A and B at 7 years were 80% (CI 66-89) and 60% (CI 32-80), respectively (P = 0.07). With this treatment protocol, the factors which adversely affected the outcome were age (<2 years and >10 years) and T-cell subtype. Sex, white blood count at diagnosis, and FAB subtypes were not statistically significant prognostic factors. CONCLUSIONS: The treatment outcomes were comparable with those reported from the MRC UKALL X trials.

PMID: 9950200 [PubMed - indexed for MEDLINE]

1: Zhonghua Liu Xing Bing Xue Za Zhi 1996 Aug;17(4):229-32 Related Articles, Books, LinkOut

[A case-control study of childhood leukemia]

[Article in Chinese]

Lu JC, Shi LY.

Guangzhou Medical College.

A 1:1 matched case-control study was conducted to investigate the etiological factors of childhood leukemia. It was found that there were five risk factors: (1) children living in the environmental pollution area, OR (95% CI) = 2.84 (1.14-7.10); (2) exposure to extreme low frequency electronmagnetic field (ELF), OR (95% CI) = 2.01 (1.18-3.42); (3) history of postnatal X-ray exposure, OR (95% CI) = 4.53 (1.68-12.21); (4) history of taking chloramphenicol, OR (95% CI) = 3.60 (1.62-8.01); (5) history of taking, antipyretic or analgesic drugs, OR (95% CI) = 1.93 (1.09-3.42). A protective factor was also discovered. Mothers often eating fish, pork and other meat foods, OR (95% CI) = 0.33 (0.18-0.59). The analysis of the population attributable risk showed that 91% of the childhood leukemia cases might attribute to these five risk factors. The interaction among these etiological factors was estimated. Results showed that there was a positive interaction between the X-ray exposure and chloramphenicol on additive model, the relative excess risk due to interaction (RERI) of childhood leukemia was 3.04.

PMID: 9387589 [PubMed - indexed for MEDLINE]

1: Cancer Causes Control 1993 Jul;4(4):361-8 Related Articles, Books, LinkOut

Prior medical conditions and the risk of adult leukemia in Shanghai, People's Republic of China.

Zheng W, Linet MS, Shu XO, Pan RP, Gao YT, Fraumeni JF Jr.

Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD.

A population-based case-control interview study of 486 adult leukemia cases and 502 healthy controls was carried out in Shanghai, People's Republic of China during 1987-89 to evaluate the etiologic role of prior medical conditions, medications, and diagnostic X-rays. Risks were examined separately for 236 cases with acute non-lymphocytic leukemia (ANLL), 79 with chronic myeloid leukemia (CML), 81 with acute lymphocytic leukemia (ALL), and 21 with chronic lymphocytic leukemia (CLL). Little difference was found between cases and controls for prior history of diabetes, hypertension, allergic conditions, most medications, and diagnostic X-rays. A few significant associations were observed for appendectomy, tuberculosis, and for several other chronic disorders with specific leukemia cell types, but the odds ratio estimates for most of these ranged from two to three and, with the exception of the two specified above, were based generally on five or fewer exposed controls. In contrast to an association with childhood leukemia in Shanghai, prior use of chloramphenicol was not linked with ANLL or other forms of adult leukemia. Further research is needed to clarify the relation of specific medical conditions and exposures with particular subtypes of leukemia, and to examine reasons for the low incidence of CLL in China and other Asian populations.

PMID: 8347786 [PubMed - indexed for MEDLINE]

1: J Natl Cancer Inst 1983 Apr;70(4):589-92 Related Articles, Books, LinkOut

Incidence of childhood tumors in Shanghai, 1973-77.

Tu J, Li FP.

Data of the Shangai Tumor Registry were analyzed for incidence of cancer in children under 15 years of age, 1973-77. The incidence of all malignant neoplasms combined was 104.7 per million boys and 89.2 per million girls. Leukemia, brain tumors, and lymphomas comprised 70% of all childhood tumors in Shangai. Compared with U.S. whites, Shangai children had higher rates of myeloid leukemia and liver cancer and lower rates of lymphoid cancers and tumors of the kidney, eye, soft tissue, and testis. Effects of migration on tumor rates among Chinese children are largely unknown and merit additional study.

PMID: 6572746 [PubMed - indexed for MEDLINE]

1: Cancer 1988 Aug 1;62(3):635-44 Related Articles, Books, LinkOut

A population-based case-control study of childhood leukemia in Shanghai.

Shu XO, Gao YT, Brinton LA, Linet MS, Tu JT, Zheng W, Fraumeni JF Jr.

Shanghai Cancer Institute, Epidemiology Department, People's Republic of China.

A population-based case-control interview study of 309 childhood leukemia cases and 618 healthy population control children was conducted in urban Shanghai, China. Like some studies in other countries, excess risks for both acute lymphocytic leukemia (ALL) and acute nonlymphocytic leukemia (ANLL) were associated with intrauterine and paternal preconception diagnostic x-ray exposure, and with maternal employment in the chemical and agricultural industries during pregnancy. ANLL was linked to maternal occupational exposure to benzene during pregnancy, whereas both ALL and ANLL were significantly associated with maternal exposure to gasoline and the patient's prior use of chloramphenicol. New findings, previously unsuspected, included an association of ANLL with younger maternal age at menarche (odds ratio [OR] = 4.3; 95% confidence interval (CI) = 1.3-13.9); a protective effect for long-term (greater than 1 year) use of cod liver oil containing vitamins A and D for both ALL (OR = 0.4; 95% CI = 0.2-0.9) and ANLL (OR = 0.3; 95% CI = 0.1-1.0); and excess risks of ANLL among children whose mothers were employed in metal refining and processing (OR = 4.6; 95% CI = 1.3-17.2) and of ALL associated with maternal occupational exposure to pesticides (OR = 3.5; 95% CI = 1.1-11.2). No relationships were found with late maternal age, certain congenital disorders, or familial occurrence, which have been related to childhood leukemia in other studies. In contrast with other reports, an excess of leukemia, primarily ANLL, occurred among second or later-born rather than firstborn children.

PMID: 3164642 [PubMed - indexed for MEDLINE]

1: Zhonghua Yu Fang Yi Xue Za Zhi 1989 Jul;23(4):234-6 Related Articles, Books, LinkOut

[Epidemiological survey of childhood leukemia]

[Article in Chinese]

Kuang XF.

This paper reports epidemiological data of childhood leukemia in the 14 years 1973-1986 in Qidong county, Jiangsu province. Mortality of childhood leukemia was 1.74 per 10 million, taking first place among various malignant tumors of children. The annual mortality distribution of this disease and the age and season at death showed no significant difference, But finer age grouping of death rates revealed remarkable difference. Thus, in 0-4 age-group the mortality was 2.95 per 10 million higher than the remainder. Childhood leukemia mortality by space-Time Clusters analysis showed the significance of difference lobe P greater than 0.05, suggesting that childhood leukemia mortality in space and time clusters were random.

PMID: 2627840 [PubMed - indexed for MEDLINE]