Trends in childhood and adolescent cancer survival in Sweden 1960 through 1984

The temporal changes in childhood and adolescent cancer survival in Sweden 1960-1984 were analyzed. Complete follow-up through 1986 of 6,262 patients younger than 20 years at diagnosis revealed that the overall 5-year survival rates increased from 36.1 to 65.7% in males and from 43.6 to 73.6% in females. The temporal trends differed markedly between age groups and tumour sites and types. Over the study period, 5-years, survival for testicular cancer increased from 46.9 to 87.2%, kidney cancer, predominantly Wilms' tumour from 35.5 to 77.1% (with a higher rate of 89.1% in 1975-1979), Hodgkin's disease from 61.2 to 91.9%, non-Hodgkin's lymphoma from 32.5 to 76.6%, and all leukemias from 8.9 to 58.7%. Only a moderate improvement was noted for tumours of the bone, muscle and connective tissue, and survival rates for tumours of the nervous system remained largely unchanged. Our data reflect the remarkable therapeutic improvements that have occurred for cancer in the young and indicate that these improvements have rapidly become available in Sweden.

Causes of death in a paediatric oncology unit

The records of 101 patients (64 males and 37 females) registered at Bristol Children's Hospital who died between January 1986 and December 1989 were reviewed to determine the cause of death. Nineteen patients (19%) died without obtaining remission and 6 (6%) in first remission. Seventy-six (75%) died after relapse; three during re-induction and two in second remission. The causes of death were active disease in 85 patients (84%), active disease and infection (4%), active disease and other factors (4%), infection only (3%), toxic cardiomyopathy (2%), graft versus host disease (2%), and second malignancy (1%).

Trends in cancer survival in Vaud, Switzerland

Survival rates from the Vaud Cancer Registry were compared for incident cases registered in 1974-1978 and 1979-1983. No appreciable difference was evident for most major cancer sites: 5-year relative survival rates were 0.21 in 1974-1978 and 0.23 in 1979-1983 for stomach, 0.49 and 0.46 for colon, 0.45 and 0.47 for rectum, 0.04 and 0.03 for pancreas, 0.08 and 0.10 for lung, 0.41 and 0.42 for kidney, 0.21 and 0.13 for brain, and 0.32 and 0.30 for multiple myeloma, respectively. A modest advancement in 5-year relative survival rates was, however, registered for total cancer mortality (non-melanomatous tumours excluded, from 0.41 to 0.43) while, with regard to specific sites, a significant improvement was seen only for cancer of the testis (from 0.73 to 0.88). More than 10% non-significant improvements in survival were recorded for melanomatous skin cancer (from 0.67 to 0.78), thyroid cancer (from 0.73 to 0.85), particularly in females, non-Hodgkin lymphomas (from 0.37 to 0.45), Hodgkin's disease (from 0.61 to 0.78), cancer of the ovary (from 0.28 to 0.32) and the prostate (from 0.44 to 0.52). However, significant declines in survival rates were seen for cancer of the larynx, gallbladder and biliary tract, and for connective tissue neoplasms. A few differences in the modification of relative survival rates according to age (less than 60 versus greater than or equal to 60 years) were noted for a few cancer sites. Changes were larger in older patients with respect to cancer of the prostate and thyroid and non-Hodgkin lymphomas (increases) and connective neoplasms (decreases). Conversely, changes in survival were greater or restricted to younger individuals for testis, bladder and leukaemias (improvements) and cancer of the mouth or pharynx (decline), thus suggesting the different play of age-specific biological characteristics of some tumours, in addition to diagnostic improvements and gradual spread of effective cancer treatments to more advanced age groups.

Low-dose cytosine arabinoside for treating hypocellular acute leukemia in the elderly

Ten previously untreated elderly patients with hypocellular acute leukemia received a low dose of cytosine arabinoside (Ara-C), 10 mg/m2 injected subcutaneously every 12 hours for 14-28 days. Six patients achieved a complete remission (CR) for periods ranging for 6-23 months (median 8.5 months) and the others had a partial remission (PR). Relapse has occurred in three patients to date. The median survival ranged from 10-24 months (median 14.5 months). Only two of the six patients, in whom bone marrow biopsy was performed at CR, had a normal cellularity. This change, however, did not appear to be a significant prognostic factor in those patients. In seven patients who achieved a CR or PR low-dose Ara-C was administrated as maintenance therapy at the same low dose for 10 days each month. Treatment was well tolerated in all patients despite for myelosuppression. There were no drug-related deaths. These observations suggest that low-dose Ara-C is effective in treating elderly patients with hypocellular acute leukemia.

A comparative ecological study of selected cancers in Kanawha County, West Virginia

This study compares mortality rates for selected causes of death in Kanawha County, West Virginia, to rates reported in a number of geographically defined populations for 1950-1984. Specific conditions selected for study included cancers of the biliary passages and liver, the bladder and other urinary organs, and the central nervous system (CNS), as well as leukemia and aleukemia, lymphosarcoma and reticulosarcoma, Hodgkin's disease, and cancer of all other lymphopoietic tissue. The analysis made use of several techniques for the investigation of ecological data, including the modeling of rates using Poission regression. The primary findings of this study concern two subgroups of cancers of the lymphatic and hematopoietic tissue: (1) leukemia and aleukemia, and (2) lymphosarcoma and reticulosarcoma. For both subgroups of cancers, white male residents of Kanawha County show evidence of significantly elevated mortality rates over the 35-year period of this study.

Non-aggressive therapy for chronic myeloid leukaemia in blastic transformation

A total of 40 patients presenting with chronic myeloid leukaemia in blastic transformation were treated with a non-aggressive chemotherapy regimen consisting of vincristine, cytosine arabinoside and thioguanine. Remissions were achieved by 3/10 (30%) patients displaying lymphoid transformation (remission duration, 2, 3, and 5 months, respectively) and by 5/30 (17%) subjects exhibiting myeloid changes (duration 2+, 4, 4, 5 and 7 months, respectively). Myelosuppression was the major toxicity and non-haematological toxicities were mild and acceptable. The median survival of patients exhibiting lymphoid and myeloid blastic transformation as measured from the time of transformation was 6 and 3 months, respectively, but the difference was not statistically significant. Three subjects displaying lymphoid transformation and five showing myeloid changes survived for greater than 12 months after the time of transformation.

General mortality and respiratory cancer among a cohort of male chemical workers in California

Cohort mortality and nested case-control studies were conducted involving 2,901 men employed 1 year or more between 1940 and 1986 at any of four California facilities of a major chemical company. Employees experienced fewer deaths from each of the major causes than were expected based on U.S., California, and local county mortality rates. Respiratory cancer was significantly elevated in one socioeconomic category comprised of operators (SMR = 157, 95% CI = 109-220). The 34 cases who died from respiratory cancer and 136 matched controls, all of whom were operators, were included in a nested case-control study. Departments in which subjects had worked were grouped into 13 work assignment or product categories by an industrial hygienist without knowledge of case-control status. Smoking habits and other occupational exposures were ascertained by telephone interview from subjects or surrogate-responders. As expected, current cigarette smoking was strongly related to respiratory cancer. After adjustment for smoking, cases were significantly more likely than controls to have ever worked in one of the 13 work areas (supervision, services, and business support). However, no dose-response relationship was evident with duration of employment in this work area and the departments involved were associated with plant security and not chemical production. Results were similar when a 15-year latency period was assumed. These findings suggest that the excess of respiratory cancer mortality among operators was most likely due to differences in cigarette smoking or other factors not ascertained, rather than to a specific occupational exposure.

Improved results of allogeneic bone marrow transplantation for advanced hematologic malignancy using busulfan, cyclophosphamide and etoposide as cytoreductive and immunosuppressive therapy

Twenty-four patients between the ages of 8 and 48 years (median 27.5) with high-risk for relapse hematologic malignancy received a marrow transplant from an HLA and MLC compatible sibling donor after chemotherapy with busulfan, 4 mg/kg/day for 4 days by mouth, cyclophosphamide 60 mg/kg/day i.v. for 2 days, and etoposide 60 mg/kg i.v. over 4 h on the first day of cyclophosphamide treatment (BU/CY/VP). Toxicity consisted of mucositis, skin rash, and nausea and vomiting in all patients, transient fever thought to be due to etoposide administration in 16/24 (67%) patients, and clinical veno-occlusive disease (VOD) of the liver in 4/24 (17%). There were nine deaths from causes other than recurrent disease in the first 100 days after transplant and two deaths after day 100, a total transplant mortality of 11/24 (46%). Three patients relapsed, but 10/24 (40%) remain alive and disease free 26-182 weeks (median 60 weeks) from transplant. These results compare favorably with results in a group of 12 similar risk patients treated with total body irradiation (TBI) containing regimens during an overlapping time period. Six of the TBI patients have had persistent or recurrent disease and only two (17%) are currently alive and disease free. The probability of disease persistence or relapse is 67% in the TBI group and 20% in the BU/CY/VP group (p less than 0.02).

A prospective randomised trial of cyclosporin and methotrexate versus cyclosporin, methotrexate and prednisolone for prevention of graft-versus-host disease after HLA-identical sibling marrow transplantation for haematological malignancy

A prospective randomised trial was performed in patients given HLA-identical sibling bone marrow transplants for haematological malignancy comparing the combination of cyclosporin and methotrexate (CM) (n = 20) with the combination of cyclosporin, methotrexate and prednisolone (CMP) (n = 21) as prophylaxis for graft-versus-host disease (GVHD). There was no significant differences between the two arms for the incidence of acute GVHD grades I-IV, acute GVHD grades II-IV, chronic GVHD, interstitial pneumonitis, relapse, survival and disease-free survival. The actuarial incidence of acute GVHD grades II-IV in the CMP group was 10% and in the CM group 15% (ns). The incidence of leukaemic relapse in good risk patients was 42% in the CMP group and 40% in the CM group (ns), although the majority of these relapses were cytogenetic relapses only in patients with chronic myeloid leukaemia. The incidence of acute GVHD grades II-IV in both arms of the current trial was significantly lower than in our previous trial comparing cyclosporin and methotrexate as single agents. Leukaemic relapse is now the principal cause of treatment failure in this patient population. We conclude that prednisolone should not be included as part of the prophylactic GVHD regime and that further improvement in therapeutic outcome is dependent upon better control of the underlying malignancy.

Childhood leukaemia and poliomyelitis in relation to military encampments in England and Wales in the period of national military service, 1950-63

OBJECTIVE

To determine if any excess of childhood leukaemia was associated with the large and increasing numbers of national military servicemen in 1949 and 1950, particularly in rural districts. This would be a further test of the hypothesis that childhood leukaemia can originate in an infection, the transmission of which is facilitated by an increased number of unaccustomed contacts in the community.

DESIGN

Rural and urban districts, aggregated by county, were ranked by proportion of servicemen, and five groups containing similar numbers of children were created. In addition, individual local authority districts were ranked and grouped in tenths. Mortality from childhood leukaemia 1950-3 was examined in these groups. Data on infectious diseases were also examined, as well as data on leukaemia in later periods.

SETTING

England and Wales.

SUBJECTS

Children aged under 15 years.

RESULTS

In 1950-3 but not subsequently a significant excess of leukaemia in children under 15 was found in the fifth of county groupings with the highest proportions of servicemen. This was due mainly to a significant excess in children under 2 years (and especially in those under 1 year) in rural districts. It was confirmed among the tenth of local authority districts with the highest proportion of servicemen. These rural areas showed significantly more notifications of, and deaths from, poliomyelitis among children than the rural average.

CONCLUSIONS

The findings support the infection hypothesis. That the excess of leukaemia was greatest in children under 1 year suggests transmission of infection among adults and thence to the fetus. The pattern of spread of poliomyelitis may also have been influenced by the presence of large numbers of servicemen.

Cancer mortality in the USSR, 1986-88

Mortality rates in the USSR for the major cancer sites have been computed for the period 1986-88 from official numbers of certified deaths and population estimates provided by the World Health Organization databank, and compared with rates for 26 other European countries. Among males, elevated mortality rates (age-adjusted, world standard) were observed for cancer of the oral cavity and pharynx (6.6/100,000), oesophagus (8.4/100,000) and larynx (6.8/100,000). Mortality from cancer of the stomach (38.4/100,000 males and 16.5/100,000 females, for a total of 87,000 deaths per year) was the highest in Europe. Likewise, overall lung cancer rates among males (61.0/100,000, for over 77,000 deaths per year) were among the highest in Europe, and showed substantial rises over the last 2 decades. Lung cancer mortality in females was comparatively low (6.9/100,000), and increased only moderately. Rates for cancers of the intestine (14.6/100,000 males and 10.6/100,000 females) and of the female breast (12.9/100,000) were comparatively low as compared to most other European countries, and those for prostatic cancer (5.9/100,000) were the lowest registered in Europe. In contrast, mortality for cancer of the uterus (9.7/100,000) was among the highest in Europe, probably due to high mortality from cervical cancer. Priorities for cancer control in the Soviet Union are thus reduction of consumption of tobacco and alcohol, which largely explain the high rates for lung and upper digestive and respiratory sites, improvements in diet composition and food storage to reduce the substantial excess of stomach cancer, and rational screening for cervical cancer.

Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy

Ninety-two consecutive adult patients admitted with acute life-threatening complications of haematological malignancy were studied to determine long term outcome. The quality of life was evaluated in seven long term survivors who are currently alive more than 1 year after hospital discharge using three validated methods: the Nottingham Health Profile, the Hospital Anxiety and Depression Scale and the Perceived Quality of Life Scale. Patients were also asked whether they had returned to work, whether their daily activities were limited and whether they would be willing to undergo intensive care again under the same circumstances. The in-hospital mortality rate was 77%. Median duration of long term survival was 23 months (range 6 weeks to 8 years). Long term survival did not appear to be related to either the aetiology or the severity of the acute illness, but seemed to be determined solely by the nature and progress of the underlying malignancy. The quality of life of six of the seven long term survivors is good, while that of the other is acceptable. None of the patients reported any increased limitation of their daily activities, five had returned to full time employment and all seven stated that they would be willing to undergo intensive care again under the same circumstances.

Depressed mood and other variables related to bone marrow transplantation survival in acute leukemia

Routine psychiatric evaluations of 100 adult patients undergoing allogeneic bone marrow transplantation for acute leukemia were reviewed to examine the possible relationship of psychiatric and psychosocial factors to duration of survival following the procedure. Three variables were found to independently affect outcome: illness status (first remission vs. other status), presence of depressed mood, and the extent of perceived social support. Patients transplanted while in their first remission had significantly improved survival; patients with depressed mood, regardless of specific psychiatric diagnosis, had poorer outcomes; and patients with a high level of perceived social support had improved survival. The possible mechanisms by which these variables affect outcome are discussed.

Cancer deaths due to all causes, its relationship with vehicle travel in Australia, Japan and European countries

Results of analysis of statistical data gathered and studied over a period from 1968-1989 have led to findings indicating that all cancers have a common cause. A relationship has been studied between the number of deaths due to all types of cancer and road accident deaths in time, by age, sex, and country. Road accident deaths in this paper are considered to be a measure of miles travelled for both males and females.

Eradication of leukaemic marrow and prevention of leukaemia relapse with total body irradiation and bone marrow transplantation

A series of studies was carried out to determine the effect of allogeneic bone marrow transplantation (BMT) on leukaemia. The study aimed at two different, but strictly linked issues: (1) identification of the eradication capability of BMT, and (2) evaluation of the effect of BMT, both in preventing relapse and in producing long-term disease-free survival. Fifty-four patients allografted for leukaemia were evaluated at various intervals, after bone marrow transplantation, for the presence of host haemopoiesis using red-blood-cell and cytogenetic markers. Among 40 patients in remission, 10 showed functional host and donor haemopoiesis (mixed chimerism), while in 30, host haemopoiesis was never detected (complete chimerism). Seven of the 14 evaluable patients who relapsed showed the reappearance of host haemopoiesis at the time of relapse. The records of received doses of TBI indicate that patients who achieved mixed chimerism, either relapsing or not, received significantly lower doses than complete chimeras. However, some patients with complete chimerism received a TBI dose equivalent to the dose received by those with mixed chimerism, suggesting that the TBI dose is not the only factor determining the reappearance of host haemopoiesis. The data on chimerism and relapse suggest that there is heterogeneity in radiosensitivity between normal marrow cells and leukaemic cells, and further, within the different types of leukaemia. The incidence/severity of acute and chronic graft-vs-host disease (GvHD) was significantly higher in complete chimeras than in mixed chimeras suggesting that mixed chimerism may play a role in the development of tolerance; however, it could be the tolerance (i.e. absence of GvHD) which is responsible for the persistence of host haemopoietic cells. One-hundred-and-sixty-eight patients undergoing allogeneic bone marrow transplantation (BMT) for acute myeloid leukaemia (AML) and chronic myeloid leukaemia were analyzed for risk factor associated with relapse. All patients received marrow from an HLA identical sibling after preparation with cyclophosphamide 120 mg/kg and total body irradiation (TBI) of 330 cGy on days -3, -2, -1. There was a difference of +/- 18% between the nominal total dose of 990 cGy and the actual received dose as indicated by dosimetric recordings. While interstitial pneumonitis had minimal impact on survival there was a considerable difference in the incidence of relapses. The incidence of relapse was higher in patients receiving less, than in patients receiving more than 1000 cGy respectively and this had a major impact on survival. However, transplant-related mortality was slightly higher in the group of patients receiving higher doses of TBI.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of 1-hydroxyvitamin D3 for prolongation of leukemic transformation-free survival in myelodysplastic syndromes

Leukemic transformation (LT) free survival was studied in 30 patients with myelodysplastic syndromes (MDS). In 15 cases, 4-6 micrograms/day of 1-hydroxyvitamin D3 was administered, for a median duration of 17 months (D-group), other subjects had no therapy (N group). LT free survival of the D group had significant advantage over that of the N group according to the Kaplan-Meier method (P less than 0.001). In addition, 7 cases in the N group developed acute leukemia, in contrast to only one in the D group (P less than 0.05). These results suggest that oral administration of 1-hydroxyvitamin D3 prevents the progression of MDS to overt leukemia under the effect of differentiation capacity from blasts to monocytes.

Allogeneic bone marrow transplantation in childhood leukemia

Allogeneic bone marrow transplantation was performed in 94 patients with hematologic malignancies or other various diseases during the period between March 1982 and November 1990 at Tokai University Hospital. Projected disease-free survival rates of HLA genotypically identical marrow recipients were 88.9% for chronic myeloid leukemia transplanted in the first chronic phase (N = 9), 90.9% for acute leukemia in the first complete remission (N = 15), 54.5% for acute leukemia in later remissions (N = 14), 62.5% for solid tumors (N = 8) and 0% for patients transplanted in relapse (N = 7). The rate for HLA-mismatched marrow recipients with leukemia was 27.8% (N = 16). For patients with non-neoplastic diseases it was 100% regardless of HLA-compatibility (N = 26). The quality of life in long-term surviving pediatric marrow recipients has been acceptable. Common abnormalities among survivors are long-lasting hypogonadism due to radiation and subclinical impairment of lung function in the first year post-BMT. About two-thirds of children experienced a transient decrease in growth velocity in the immediate posttransplant period.

Immunological classification of childhood acute lymphoblastic leukemia

Seven hundred and forty-four newly diagnosed patients with acute leukemias between 1978 and 1990 were classified on the basis of immunological phenotypes. The majority of the patients were enrolled in the Tokyo Children's Cancer Study Group (TCCSG) studies. The incidence of subclassification of acute leukemias in this study was as follows: 522 patients with ALL (70%), 139 patients with ANLL (18%), 29 patients with biphenotypic leukemia, 8 patients with Ph1-positive acute leukemia (Ph1-AL), and 45 patients with infant leukemia. ALLs were classified into common ALL (cALL, 77%), T-ALL (15%), B-ALL (4%), and unclassified ALL (3%). The incidence of ALL subtypes in this study reflected those of TCCSG. Biphenotypic leukemias were categorized into 4 groups as follows; 1) cALL with positive myelomonocytic antigen(s) (N = 11), 2) unclassified ALL with positive myelomonocytic antigen(s) (N = 5), 3) ANLL with positive B-lymphoid antigen(s) (N = 4), and 4) acute leukemia with positive T-lymphoid and myeloid antigen(s). Infant leukemias were classified into ALL type (N = 27) and ANLL type (N = 18). In this present study, clinical features and immunological phenotypes of the acute leukemias with a poor prognosis, i.e. biphenotypic leukemia, Ph1-AL, and infant leukemia are analyzed and discussed.

[Cost of leukemia treatment]

Medical cost has increasingly become an important problem in the medical practice. As one of the useful fields of computer in the hospital, we have analyzed the costs of chemotherapy and bone marrow transplantation in patients with leukemia who were diagnosed between 1983 and 1986 and followed up till Dec. 1989. For CML the difference in the cost was 5 million yen and a survival rate was 75% and was higher in BMT than in chemotherapy. For Acute leukemia the difference of the costs was 8 million yen and survival rates were 89% and 30%. These data may show that BMT is a very effective and economical treatment for leukemia. In this study we have analyzed only the direct medical cost paid by the governmental insurance, however there seems necessary many other costs which are not covered by the insurance such as the cost for the family members, the cost for cryopreservation of cells and sterilization tentatively covered by the hospital or the cost of blood or marrow bank which are covered or should be covered by the government. Evaluation of the treatment outcome by the parameters such as length and quality of life, productivity of the patient, prevention of the loss of social investment including education on the patient, seemed also necessary for justification of the medical cost.