Acute Leukemias - Republican Scientific Medical Library

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a 5.2 · Demographic Patterns 79 Table 5.1. Age-adjusted incidence and mortality rates per 100000 persons, and 5-year relative survival rates Gender Race Incidence Mortality 5-year survival Acute lymphoblastic leukemia All leukemias All cancers Acute lymphoblastic leukemia All leukemias All cancers Acute lymphoblastic leukemia All leukemias All cancers All ages Total All 480.4 12.4 1.4 197.8 7.6 2.2 66.3 47.1 62.9 White 489.1 13.1 1.5 195.3 7.8 0.5 67.8 48.9 64.9 Black 519.3 9.6 0.7 248.1 6.8 0.4 57.2 35.5 48.8 Males All 567.0 16.3 1.6 247.5 10.2 3.1 66.6 47.8 62.5 White 569.7 17.1 1.7 242.5 10.4 0.6 68.2 49.6 64.7 Black 692.5 12.4 0.8 339.4 8.9 0.5 60.1 35.0 46.7 Females All 421.9 9.6 1.2 165.5 5.8 1.6 66.1 46.2 63.6 White 435.6 10.1 1.3 164.5 6.0 0.4 67.3 47.8 65.2 Black 404.1 7.8 0.7 194.3 5.4 0.3 54.0 36.0 52.0 Ages 0–14 Total All 15.0 4.6 3.6 2.5 0.8 0.4 78.6 80.2 86.4 White 16.1 – * – 2.5 – – – – – Black 10.7 – – 2.4 – – – – – Males All 15.6 4.9 3.9 2.7 0.8 0.4 79.9 – – White 16.7 – – 2.7 – – – – – Black 10.7 – – 2.6 – – – – – Females All 14.3 4.2 3.4 2.3 0.7 0.3 73.0 – – White 15.5 – – 2.4 – – – – – Black 10.6 – – 2.2 – – – – – All ages Incidence: 1998–2002 (SEER 9 areas); All Cancers: Table II-2; Leukemia: Table XIII-2; ALL: Table XIII-3 Mortality: 1998–2002 (NCHS public use US data file); All Cancers: Table II-3; Leukemia: Table XIII-8; ALL: Tables I-4, I-5, I-6 Survival: 1995–2001 (SEER 9 areas); All Cancers: Table II-4; Leukemia: Table XIII-8; ALL: Table XIII-9 Ages 0–14 Incidence 1998–2002 (SEER 9 Areas) Table XXVIII-7 Mortality 1998–2002 (NCHS public use US data file for entire US) Table XXVII-7 Survival 1995–2001 (SEER 9 Areas) Table XXVII-8 *not reported Source: SEER Cancer Statistics Reviews 1975–2002
80 Chapter 5 · Acute Lymphoblastic Leukemia: Epidemiology and Etiology Fig. 5.1. Survival rates for childhood ALL. Five-year relative survival rates for ALL and AML: End Results Group National Cancer Institute Surveillance, Epidemiology and End Results Program, 1996. Squares: ALL; circles: AML represent defined time periods. The “best fit” curve was drawn by the author (from Kersey [54]). 5.2.3 Mortality ALL represents less than 1.1% of total US cancer related deaths and 28.9% of all leukemia deaths. In US children, however, ALL represents almost 16% of total cancer mortality and 50% of all leukemia deaths. Total leukemia mortality rates in whites of both sexes decreased from the 1980s through 2002. In blacks of both sexes, however, total leukemia mortality rates increased after 1975, peaking in 1983 among females and in 1991 among males, then decreasing through 2002. For all children considered together, the mortality rates both for total leukemia and for ALL declined from 1975 to 2002, but the rate of decrease was greater in the 1990s [117]. 5.2.4 Sex Differences Incidence rates for total leukemia, and to a lesser extent for ALL, are higher among males than among females, and this gender difference is considerably more pronounced among whites (70% more leukemia in males and 60% more ALL in males) than among blacks (30% and 15%, respectively). In children, the incidence rates for all leukemias, and for ALL, are slightly higher in males than in females, up to about a 30% excess [77]. Similar patterns are seen in the mortality data for all leukemias, but for ALL male rates show an even greater excess [117]. 5.2.5 Race Differences Overall differences in incidence and mortality rates by race are also noteworthy. In the USA, for leukemia, for males, females, and all combined, whites have higher incidence rates than blacks (30–40% excess), and this same pattern is seen even more strongly for ALL (85– 215% excess). A similar pattern is seen for mortality [117]. In children, SEER summaries provide tabulations of race-specific data only for all cancers [117]. For those data, whites have about a 45–55% excess in incidence rates, depending on gender, and similarly for mortality rates, whites have a 5–10% excess depending on gender. Other studies suggest that the rate of ALL in white children is double that in black children in the USA [43, 77]. 5.2.6 Age Differences Leukemia incidence increases from birth through age 3, then decreases until about age 50, when rates begin to increase slowly. ALL incidence rates increase more dramatically from birth to age 3 (up to more than 9 cases per 100 000 per year), drop off to lower levels until about age 50 (less than 1 per 100 000 per year), and then increase slightly, but never approach the rates observed between ages 1 and 14 (Fig. 5.2). The peak incidence period is from age 2–5 [145] with a smaller, secondary peak after age 60 (Fig. 5.3). It is interesting to note that the age 2–5 peak in ALL was noted first in Western countries between 1920 and 1945, thereafter in Japan and China, and the incidence rate in affluent countries continues to increase at a rate of about 1% per year [38]. Understanding the mechanism of this unexplained difference between Western, affluent, developed countries and those in the developing world might help unlock the etiologic secret of what causes the leukemias and ALL. 5.2.7 Parental and Birth Characteristics Researchers have noted a variety of patterns among parental and birth characteristics of leukemia and ALL cases. For example, first-born babies have a higher risk of ALL, as do high-birth-weight babies [124], babies whose mothers are over 35 years of age, and mothers who have had a prior fetal loss [120]. Maternal cigarette
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E.H. Estey · S.H. Faderl · H. M.
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E. H. Estey Department of Leukemia
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VI Table of Contents 14 Philadelphi
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VIII Contributors S. H. Faderl Depa
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X Contributors D. Wartenberg Depart
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Therapy of AML Elihu Estey Contents
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Page 79 and 80: Molecular Biology and Genetics Meir
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General Approach to the Therapy of
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a 9.3 · New Agents 133 dose methot
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a References 135 4. Gökbuget N, Ho
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138 Chapter 10 · Recent Clinical T
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146 Chapter 11 · Conventional Ther
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ALL Therapy: Review of the MD Ander
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a 12.2 · The Hyper-CVAD Regimen in
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a 12.3 · Subset-Specific Approache
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Treatment of Adult ALL According to
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a 13.2 · Therapy for Younger (15-6
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a 13.3 · Therapy of Ph/BCR-ABL-Pos
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a 13.5 · Prognostic Factors 173 13
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a References 175 Only patients with
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Philadelphia Chromosome-Positive Ac
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a 14.2 · Molecular Biology of the
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a 14.3 · Treatment of Ph+ ALL 181
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a 14.4 · Hematopoietic Stem Cell T
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a References 185 2. Kurzrock R, Sht
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a References 187 56. Mori T, Manabe
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a References 189 acute lymphoblasti
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192 Chapter 15 · Burkitt’s Acute
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204 Chapter 16 · Treatment of Lymp
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216 Chapter 17 · The Role of Allog
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230 Chapter 18 · The Role of Autol
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238 Chapter 19 · Novel Therapies i
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248 Chapter 20 · Minimal Residual
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264 Chapter 21 · Central Nervous S
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276 Chapter 22 · Relapsed Acute Ly
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278 Chapter 22 · Relapsed Acute Ly
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Emergencies in Acute Lymphoblastic
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a 23.5 · Hyperleukocytosis 283 LA
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a 23.9 · Neurological Complication
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a References 287 29. Hingorani AD,
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Subject Index A aberrant methylatio
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a Subject Index 291 CREB, see enhan
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a Subject Index 293 MUD, see matche
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