Do Surveillance Tests for Relapse Improve Survival After Chemotherapy for Paediatric Acute Leukaemia? A Systematic Review.

Abstract

Acute leukaemias are the commonest cancers in children and young people (CYP). Off-treatment surveillance is assumed to improve relapse detection, but whether this affects subsequent survival and quality of life is unclear. This systematic review searched 13 databases and two trial registries in December 2022. Studies after 1990 investigating post-treatment surveillance in CYP ≤17 years old with acute leukaemias were included. Extracted outcomes included overall and event-free survivals, surveillance programme performance and cost-effectiveness. Screening, data extraction and quality assessment (using the Quality in Prognostic Studies tool) were conducted in duplicate. Data were narratively synthesised. Of 7899 records screened, 64 studies were included, of which 30 evaluated post-chemotherapy surveillance. 5672 CYP (5181 ALL, 491 AML) were included. 747 CYP experienced 800 relapses. Poor reporting hindered data extraction and quality assessment. Symptom-detected relapses were most common. Surveillance did not impact survival outcomes. Two studies demonstrated the high costs of surveillance programmes. No study reported on the experience or burdens of surveillance. The currently available evidence suggests that there is little support for the role of surveillance in detecting relapse in CYP with acute leukaemia. Prospective, longitudinal, randomised studies focused on key outcomes and high-quality reporting are needed. PROSPERO: CRD42023389281.