Survival of adults with acute lymphoblastic leukemia in Germany and the United States.
BACKGROUND
Adulthood acute lymphoblastic leukemia (ALL) is a rare disease. In contrast to childhood ALL, survival for adults with ALL is poor. Recently, new protocols, including use of pediatric protocols in young adults, have improved survival in clinical trials. Here, we examine population level survival in Germany and the United States (US) to gain insight into the extent to which changes in clinical trials have translated into better survival on the population level.


METHODS
Data were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients age 15-69 diagnosed with ALL were included. Period analysis was used to estimate 5-year relative survival (RS).


RESULTS
Overall 5-year RS was estimated at 43.4% for Germany and 35.5% for the US (p = 0.004), with a decrease in survival with increasing age. Survival was higher in Germany than the US for men (43.6% versus 37.7%, p = 0.002) but not for women (42.4% versus 40.3%, p>0.1). Five-year RS estimates increased in Germany and the US between 2002 and 2006 by 11.8 and 7.3 percent units, respectively (p = 0.02 and 0.04, respectively).


CONCLUSIONS
Survival for adults with ALL continues to be low compared with that for children, but a substantial increase in 5-year survival estimates was seen from 2002 to 2006 in both Germany and the US. The reasons for the survival differences between both countries require clarification.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany ; Cardeza Foundation and Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Dianne
D
Pulte
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Lina
L
Jansen
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Adam
A
Gondos
Institute of Cancer Epidemiology, University of Lübeck, Lübeck, Germany.
Alexander
A
Katalinic
National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany.
Benjamin
B
Barnes
Cancer Registry of Rhineland-Palatinate, Institute of Medical Biostatistics, Epidemiology, and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany.
Meike
M
Ressing
Saarland Cancer Registry, Saarbrücken, Germany.
Bernd
B
Holleczek
Cancer Registry of Bremen, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
Andrea
A
Eberle
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany ; German Cancer Consortium (DKTK), Heidelberg, Germany.
Hermann
H
Brenner
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology