Sep 1, There was significant variability in pediatric ALL survival by age at diagnosis. Though, in previous studies, the relationship between age at .. by the National Institutes of Health (NIH) COBRE Grant 8P20GM (PI. An annotated profile is available upon request from the Public Relations Department of . “Center for Pediatric Research,” NIH COBRE Principal Investigator. Pediatrics - Academic Programs - Residency. Residency training is a difficult time as you transition into the job of taking responsibility for the lives of your young.
The five-year survival rate was In addition, there were changing risk factors, namely, lifestyle, diet, and maternal factors as well as clinical practice patterns such as early diagnosis and improved treatment protocol.
To account for this time-varying survival pattern, we stratified the analysis by the year of the diagnosis grouped into 5-year intervals. Methods The study included children who were diagnosed with ALL between ages 0 and 19 years during —, whose information was reported to one of the 17 SEER registries. In addition, the population covered by SEER is comparable to the general US population with regard to measures of poverty and education [ 228 ].
The SEER registries collect population data on age, sex, race, year of diagnosis, primary tumor site, tumor morphology, and follow-up for vital status [ 232 ].
The following study variables were included in the study. Age at Diagnosis As mentioned above, the study included ALL patients 0—19 years of age at the time of diagnosis. This age classification is representative of age based pediatric ALL risk groupings used in most studies and was adopted for the purpose of this paper. This variable was recorded in single-year interval. We recoded this variable into five-year intervals —, —, —, —, —, —, —, and The interval contains only two years.
The maximum follow-up period of this study is 37 years. Sex Sex was a nominal variable in the SEER dataset and used as a binary variable with female as the reference group. Because of the limited number of subjects, we did not attempt to include the latter two categories in the analysis.
African American AA was set as the reference group in our analyses. In our preliminary exploration, we found 1. Hence, we collapsed the variable into two categories: Patients with one primary tumor site were selected as the reference group. We used two distinct immunophenotypes: This variable was treated as binary, with the T-cell as the reference group.
Radiation Therapy Information of radiation therapy was listed in the SEER dataset as a beam radiation, b combination of beam radiation with implant or isotopes, c none, d radiation, not otherwise specified, e recommended, f refused, and g unknown.
Follow-Up Time and Survival Status The follow-up time was documented as the duration from the time of diagnosis to death from any cause or the last day of the available survival information in the SEER registry.
In the dataset, those who did not experience the event death during the follow-up time were censored. The survival status was determined on a binary scale, with 0 for censored and 1 for the event or failure. Statistical Analyses The overall and cancer-specific incidence rates of mortality per thousand-person-month were estimated by age at diagnosis.
Clinical features of ALL were summarized by age group of diagnosis. Five-year and ten-year survival rates were calculated by the age group at diagnosis.
A univariable Cox proportional hazard model was performed to assess the effect of individual study variables including age group at diagnosis on survival of ALL. We utilized a multivariable Cox proportional hazard model, stratified by the year of diagnosis, to assess the extent of the association of age at diagnosis with the survival of ALL after accounting for the effect of other influential factors found in the univariable model.
In this regard, we performed two adjusted models with and without the inclusion of immunophenotype in the model. The variable immunophenotype had missing values. For both adjusted models, stratified analyses were performed by the year of diagnosis to account for the time varying survival in the follow-up period. The statistical software R version 2. Results Of the ALL patients, the overall rate of diagnosis increased with age at diagnosis before the age of three years and decreased afterwards, peaking at the age of two.
Forty-six percent of the total patients were diagnosed between ages 1 and 4 years. Interestingly, the age group 1—4 years in which most ALL diagnoses were made was also the group that experienced the lowest mortality rate. Table 1 a presented the all-cause and cancer-specific incidence rates of dying per thousand-person-month.
Children who were diagnosed in infancy had the highest mortality rate, whereas those diagnosed at the age of 3 years had the lowest mortality rate.
Faculty :: UNM Department of Pediatrics | The University of New Mexico
Both overall and cancer-specific mortality rates steadily increased as age at diagnosis increased in children older than 3 years.
Table 1 b displayed the characterization of demographics and other study variables by age group at diagnosis. Compared to females, more male children were diagnosed except in the infant group. There was a marginal difference in the distribution of race over the age at diagnosis groups, and. Beginning with the 10—14 years of age group, there was a sharp rise in the proportion of pediatric ALL patients undergoing radiation therapy.
There was a marginal difference in the distribution of pediatric ALL patients by age at diagnosis over the year of diagnosis, and. The number of diagnosis increased over the years partly due to the expansion of the SEER program. Median survival time results could be interpreted in the same fashion. Children diagnosed with ALL during infancy had the lowest 5-year interval survival rates. Children diagnosed between ages 1 and 4 years represented the highest proportion of those who survived each 5-year period, followed by the 5—9, 10—14, and 15—19 years of age at diagnosis groups.Relationship between revenue and price elasticity of demand
A significant difference was observed in the survival status with respect to the age group at diagnosis, and. The highest proportion of overall survival Table 2 showed the association of pediatric ALL survival with the age at diagnosis as well as other known prognostic factors available in the SEER dataset.
The above results indicated that the children diagnosed between ages 1 and 4 years had the lowest risk of mortality and that though the risk of mortality continuously increased among children diagnosed at older ages, it never exceeded the risk of mortality experienced by those diagnosed with ALL during infancy.
Compared to females, male children diagnosed with ALL on average were expected to have 1. Compared to the children who did not undergo radiation therapy, the irradiated children had an approximate 1. The HR of ALL mortality decreased monotonically over the year of diagnosis, which implied the time-varying survival pattern during the follow-up period. Hazard risk of mortality associated with age at diagnosis in pediatric ALL patients — SEER dataset in an univariable Cox proportional hazard model.
Table 3 presented the association of the pediatric ALL survival with the age at diagnosis after accounting for the effects of the influential covariates mentioned above using a multivariable Cox proportional hazard model, stratified by the year of diagnosis. She then completed her residency training in Pediatrics and Fellowship in Neonatology at the University of Chicago Hospitals.
Subsequently, she was a faculty member at Duke University and the U. Her academic interests include innovative, evidence-based, neonatal integrative medicine research, specifically interventions that have the potential to reduce neonatal and parental stress in the NICU, and the promotion of resilience and wellbeing among medical professionals.
Herrera is the Principal Investigator at New Mexico for the Pediatric Resident Burnout, Resilience, and Wellness Study Consortium, a national multicenter network of pediatric residency programs that seeks to define key factors in burnout and resilience in pediatric residents and the relationship to performance. Herrera is board certified in Neonatal-Perinatal Medicine and Pediatrics, and completed a fellowship in Integrative Medicine through the U.
His research interests relate to the role of intermittent hypoxia on cardiovascular morbidities observed in the very low birth weight infants and animal models. He is involved in medical education, and coordinates the Neonatal Hot Topics for the Neonatology Division, and the group of neonatal respiratory therapists.
Jantzie joined the faculty at UNM in November Her lab investigates the pathophysiology of encephalopathy of prematurity, and pediatric brain injury common to infants and toddlers.
Jantzie is dedicated to understanding disease processes in the developing brain as a means to identifying new therapeutic strategies and treatment targets for perinatal brain injury.
Her lab studies neural substrates of cognition and executive function, inhibitory circuit formation, the role of an abnormal intrauterine environment on brain development, mechanisms of neurorepair and microglial activation and polarization. Using a diverse array of clinically relevant techniques such as MRI, cognitive assessment, and biomarker discovery, combined with traditional molecular and cellular biology, the Jantzie lab is on the front lines of translational pediatric neuroscience.
Characterization of Pediatric Acute Lymphoblastic Leukemia Survival Patterns by Age at Diagnosis
Jean Lowe received her Ph. Lowe is one of the co-founders of the Developmental Care Program that provides both inpatient and outpatient services to high-risk neonates in the Neonatal Intensive Care Nursery.
She is certified in a variety of evaluation tools and continues to be the divisions gold standard evaluator for the Neonatal Research Network. Lowe has published numerous articles related to the developmental outcome of infants born extremely preterm with and without interventricular hemorrhage.
More recently her research has expanded to look at the relationship of prematurity to the development of early executive function including neuro-imaging techniques in her research studies. Dr Lowe is a collaborator on numerous studies through the Division of Neonatology, Department of Neuroscience and Mind Research Network focusing on normally developing children, preterm infants and toddlers and children alcohol exposed. Maxwell completed her fellowship in Neonatology here at the University of New Mexico in Her research interest is in investigating the relationship between intrauterine insults such as chorioamnionitis and prenatal alcohol exposure with brain injury associated with preterm birth.
Journal of Cancer Epidemiology
She completed her undergraduate degree in Human Biology at Stanford University inand completed medical school, pediatric and neonatal training at the University of Utah in Following training in developmental hematology at the University of Utah, Dr. Ohls began her career in research focused on fetal and neonatal hematology.
She has been on faculty at the University of New Mexico since Her basic science research focuses on developmental regulation of erythropoietin gene expression in the human fetus as a model organ system for evaluating the impact of preterm birth on changes in gene expression.