Interhospital Differences in the Treatment of Acute Leukaemia in Adults

During 5 years 203 adults with acute leukaemia were treated with a combination of daunorubicin, cytararabine and prednisone in the trials of the Finnish Leukaemia Group (FLG). The participating hospitals were classified according to size into 3 groups: 75 patients were treated in Meilahti Hospital (University Central Hospital, Helsinki), 87 patients—over 5 patients per year in each of the hospitals of the KOTT-group (university hospitals in Kuopio, Oulu, Tampere and Turku), and 41 patients—1 to 3 patients per year in each of the 6 hospitals of the other hospital group. The remission rate in other hospitals (21%) was significantly (P < 0.002) inferior to to those in Meilahti Hospital (54%) and in the KOTT-group (51%). Evaluation of the survival data showed no difference between Meilahti Hospital and KOTT-group, but the survival in other hospitals was significantly poorer, differing from that of Meilahti (P = 0.01) and from that of KOTT-group (P = 0.02). The durations of remissions did not differ from each other. The distribution of patients by the type of leukaemia was similar in all groups and the interhospital differences were not related to the type of leukaemia. The remission rates in other hospitals were in all age groups smaller than in the two other groups. The experience and skill gained by the doctors and the other hospital staff in treating more patients with acute leukaemia were regarded to be the main determinant of the better results achieved in the university hospitals. The slight differences in the age distribution of patients and in the facilities for supportive treatment were regarded to be of only minor importance.