title: Survival following relapse in childhood haematological malignancies diagnosed in 1974-2003 in Yorkshire, UK.
abstract: We examined population-based information on relapsed childhood haematological cancers, investigating factors that might influence both overall survival and survival following relapse among the 1177 children (0-14 years) diagnosed with a haematological malignancy in Yorkshire from 1974 to 2003, of whom 342 (29%) relapsed at least once. Leukaemia patients from more deprived areas were significantly less likely to relapse (odds ratio=0.54, 95% confidence interval 0.32-0.93 for most deprived quintile vs least deprived quintile; P(trend)=0.06), especially those with acute myeloid leukaemia (P=0.04). Neither ethnic group nor distance to the main treatment centre was associated with risk of relapse. Overall, patients who relapsed at least once had 5-year survival rates of 46% (41-51%) compared with 79% (76-81%) of those who did not. Five-year survival rates from the time of first relapse increased from 20% in 1974-1983 to 45% in 1984-2003. Length of first remission was a strong predictor of survival for leukaemia with a 46% reduced risk of death for every additional year of event-free survival. Of children who experienced a relapse, 46% survived at least 5 years, whereas just under half of patients survived 5 years beyond disease recurrence. This provides a baseline for future comparisons and demonstrates that relapsed childhood cancer need not imply a poor outcome.
authors.affiliation: Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, 30-32 Hyde Terrace, University of Leeds, Leeds, UK. r.g.feltbower@leeds.ac.uk
authors.forename: R G
authors.initials: RG
authors.lastname: Feltbower
authors.forename: S E
authors.initials: SE
authors.lastname: Kinsey
authors.forename: M
authors.initials: M
authors.lastname: Richards
authors.forename: G
authors.initials: G
authors.lastname: Shenton
authors.forename: M P
authors.initials: MP
authors.lastname: Michelagnoli
authors.forename: P A
authors.initials: PA
authors.lastname: McKinney
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology