TY - JOUR
TI - Survival trends in childhood chronic myeloid leukaemia in Southern-Eastern Europe and the United States of America
AU - Karalexi, M.A.
AU - Baka, M.
AU - Ryzhov, A.
AU - Zborovskaya, A.
AU - Dimitrova, N.
AU - Zivkovic, S.
AU - Eser, S.
AU - Antunes, L.
AU - Sekerija, M.
AU - Zagar, T.
AU - Bastos, J.
AU - Demetriou, A.
AU - Agius, D.
AU - Florea, M.
AU - Coza, D.
AU - Polychronopoulou, S.
AU - Stiakaki, E.
AU - Moschovi, M.
AU - Hatzipantelis, E.
AU - Kourti, M.
AU - Graphakos, S.
AU - Pombo-de-Oliveira, M.S.
AU - Adami, H.O.
AU - Petridou, E.T.
JO - EUROPEAN JOURNAL OF CANCER
PY - 2016
VL - 67
TODO - null
SP - 183-190
PB - Elsevier Ireland Ltd
SN - null
TODO - 10.1016/j.ejca.2016.08.011
TODO - imatinib;  protein tyrosine kinase inhibitor;  protein kinase inhibitor;  protein tyrosine kinase, absence of side effects;  acute lymphoblastic leukemia;  acute myeloblastic leukemia;  adolescent;  age;  Article;  cancer chemotherapy;  cancer mortality;  cancer patient;  cancer prognosis;  cancer registry;  cancer resistance;  cancer survival;  cancer transplantation;  child;  childhood leukemia;  chronic myeloid leukemia;  controlled study;  drug withdrawal;  Eastern Europe;  female;  geographic distribution;  hematopoietic stem cell transplantation;  human;  infant;  major clinical study;  male;  medical geography;  molecularly targeted therapy;  mortality risk;  newborn;  priority journal;  Southern Europe;  survival rate;  survival time;  treatment outcome;  trend study;  United States;  acute lymphoblastic leukemia;  acute myeloid leukemia;  antagonists and inhibitors;  Europe;  Kaplan Meier method;  Leukemia, Myelogenous, Chronic, BCR-ABL Positive;  mortality;  multivariate analysis;  preschool child;  prognosis;  proportional hazards model;  register;  trends, Adolescent;  Age Factors;  Child;  Child, Preschool;  Europe;  Europe, Eastern;  Female;  Humans;  Infant;  Infant, Newborn;  Kaplan-Meier Estimate;  Leukemia, Myelogenous, Chronic, BCR-ABL Positive;  Leukemia, Myeloid, Acute;  Male;  Molecular Targeted Therapy;  Multivariate Analysis;  Precursor Cell Lymphoblastic Leukemia-Lymphoma;  Prognosis;  Proportional Hazards Models;  Protein Kinase Inhibitors;  Protein-Tyrosine Kinases;  Registries;  SEER Program;  Survival Rate;  United States
TODO - Aim To assess trends in survival and geographic disparities among children (0–14 years) with chronic myeloid leukaemia (CML) before and after the introduction of molecular therapy, namely tyrosine kinase inhibitors (TKIs) in Southern-Eastern European (SEE) countries and the USA. Methods We calculated survival among children with CML, acute lymphoblastic (ALL) and acute myeloid leukaemia (AML) in 14 SEE (1990–2014) cancer registries and the U.S. Surveillance, Epidemiology and End Results Program (SEER, 1990–2012). We used Kaplan–Meier curves and multivariate Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Results Among 369 CML cases, substantial improvements were noted in 2-year survival during the post-TKI (range: 81–89%) compared to pre-TKI period (49–66%; HR: 0.37, 95% CI: 0.23–0.60). Risk of death was three times higher for <5-year-old children versus those aged 10–14 years (HR: 3.03, 95% CI: 1.85–4.94) and 56% higher for those living in SEE versus SEER (HR: 1.56, 95% CI: 1.01–2.42). Regardless of geographic area and period of TKI administration, however, age seems to be a significant determinant of CML prognosis (pre-TKI period, HR0–4y: 2.71, 95% CI: 1.53–4.79; post-TKI period, HR0–4y: 3.38, 95% CI: 1.29–8.85). Noticeably, post-TKI survival in CML overall approximates that for ALL, whereas therapeutic advancements for AML remain modest. Conclusion Registry data show that introduction of molecular therapies coincides with revolutionised therapeutic outcomes in childhood CML entailing dramatically improved survival which is now similar to that in ALL. Given that age disparities in survival remain substantial, offering optimal therapy to entire populations is an urgent priority. © 2016 Elsevier Ltd
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