Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3) : analysis of individual data from 258 cancer registries in 61 countries

Background Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings 164563 young people were included in this analysis: 121328 (73·7%) children, 22963 (14·0%) adolescents, and 20272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group.peer-reviewe

Population pharmacodynamic analysis of effect of three increasing doses of fludrocortisone on phenylephrine-mean arterial pressure dose-response relationship in healthy volunteers

International audienceSpecial Issue: SI Meeting Abstract: CO - 01

Assaying and PET Imaging of Ytrrium-90: 1\u3e\u3e34ppm\u3e0

Yttrium-90 is widely used to label radiopharmaceuticals with curative, or at least palliative intent. At present, both the quantitative assay, ±10% variation, and the in vivo imaging observe bremstrahllung from the 2.3 MeV β-. Detection of the positron, which is created in the E0-decay of the 1.78 MeV excited state with a 34±4 ppm branching ratio, are resolved with two detector systems. A high purity Ge spectrometer with calibrated efficiency clearly resolves the 511 keV annihilation with a 2/1 peak over the continuous bremstrahllung, providing ±5% precision in 10 min of multichannel analysis. Secondly, a simple NaI detector pair in fast coincidence yields similar precision, with trues/randoms ≈1000/1 evident in the time spectrum and the on/off-axis counting rate. The Ge detector, more tolerant to distributed sources, was used to assay the filling of a micro-Derenzo phantom, charged with 50 MBq/ml of Y-90 chloride, imperfectly stripped from unused μ-spheres. Phantoms were scanned with a Concorde μPET P4 and a CTI 933/04. The phantom\u27s 1.6-2.4-3.2-4.0-4.8 mm holes are clearly resolved, and participate residue is evident as a settled deposit. The μPET sensitivity to a centered 37 MBq point source of Y-90 is ≈24 cps trues, 37 cps randoms and 270 kcps singles, with the 4-decade drop being the result of the miniscule positron branching. Imaging is slow, but the promise of quantitative dosimetry is essential for a rational application of Y-90 radiotherapeutic agents