Department of Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.
Pediatr Blood Cancer. 2021 Apr;68(4):e28945. doi: 10.1002/pbc.28945. Epub 2021 Feb 9.
Presenting features, biology and outcome for childhood leukaemia are known to vary by ethnic origin, geographic location and socioeconomic group. This study aimed to compare presentation patterns, follow-up and clinical outcomes in Indigenous and non-Indigenous children with acute leukaemia in Australia, and to assess the impact of remoteness and area-based socioeconomic disadvantage on outcome.
A retrospective review of children aged between 1 day and 18 years who were diagnosed with acute leukaemia in South Australia (SA), Northern Territory (NT) and Western Australia (WA) between 2009 and 2018 was performed. Data were collected from children treated at the Women's and Children's Hospital, Adelaide and Perth Children's Hospital.
Analysis of 455 children treated for acute leukaemia showed that children from remote/very remote localities had inferior overall survival (p = .004). Five-year overall survival was 91.7% (95% CI: 87.9-94.3%) for children with acute lymphoblastic leukaemia (ALL) and 69.8% (56.7-79.5%) for acute myeloid leukaemia (AML). A larger proportion of Indigenous children from SA/NT were diagnosed with AML compared to non-Indigenous children (60.0% vs. 14.4%, p = .001). Indigenous children were less likely to be enrolled on clinical trials (34.5% vs. 53.1%, p = .03) and more likely to be lost to follow-up (26.1% vs. 9.2%, p = .009).
Geographic remoteness of residence is associated with inferior overall survival for Australian children with leukaemia. Indigenous children with acute leukaemia suffer from disparities in outcomes. These findings provide evidence to guide national policy in supporting appropriate resource allocation to overcome the challenges faced by children within these groups.
目前已知儿童白血病的临床表现、生物学特征和结局因种族起源、地理位置和社会经济群体而异。本研究旨在比较澳大利亚土著和非土著儿童急性白血病的表现模式、随访和临床结局，并评估偏远地区和以地区为基础的社会经济劣势对结局的影响。
对 2009 年至 2018 年期间在南澳大利亚（SA）、北领地（NT）和西澳大利亚（WA）被诊断为急性白血病的 1 天至 18 岁儿童进行了回顾性分析。数据来自阿德莱德妇女儿童医院和珀斯儿童医院治疗的儿童。
对 455 例接受急性白血病治疗的儿童进行分析显示，来自偏远/极偏远地区的儿童总体生存率较差（p=0.004）。急性淋巴细胞白血病（ALL）儿童的 5 年总生存率为 91.7%（95%CI：87.9-94.3%），急性髓系白血病（AML）儿童为 69.8%（56.7-79.5%）。来自 SA/NT 的土著儿童中，AML 的诊断比例高于非土著儿童（60.0%比 14.4%，p=0.001）。土著儿童入组临床试验的可能性较小（34.5%比 53.1%，p=0.03），失访的可能性更大（26.1%比 9.2%，p=0.009）。
居住地点的地理位置偏远与澳大利亚白血病儿童的总体生存率较低有关。急性白血病的土著儿童在结局方面存在差异。这些发现为指导国家政策提供了证据，以支持适当的资源分配，克服这些群体儿童所面临的挑战。
