Chronic Conditions, Late Mortality, and Health Status After Childhood AML: A Childhood Cancer Survivor Study Report

Authors

Lucie M Turcotte
Jillian A Whitton
Wendy M Leisenring
Rebecca M Howell
Joseph P Neglia
Rachel Phelan
Kevin C Oeffinger
Kirsten K Ness
William G Woods
E Anders Kolb
Leslie L Robison
Gregory T Armstrong
Eric J Chow

Publication Date

1-5-2023

Journal

Blood

DOI

10.1182/blood.2022016487

PMID

36037430

PMCID

PMC9837436

PubMedCentral® Posted Date

8-30-2022

PubMedCentral® Full Text Version

Post-print

Abstract

Five-year survival following childhood acute myeloid leukemia (AML) has increased following improvements in treatment and supportive care. Long-term health outcomes are unknown. To address this, cumulative incidence of late mortality and grades 3 to 5 chronic health condition (CHC) were estimated among 5-year AML survivors diagnosed between 1970 and 1999. Survivors were compared by treatment group (hematopoietic cell transplantation [HCT], chemotherapy with cranial radiation [chemo + CRT], chemotherapy only [chemo-only]), and diagnosis decade. Self-reported health status was compared across treatments, diagnosis decade, and with siblings. Among 856 survivors (median diagnosis age, 7.1 years; median age at last follow-up, 29.4 years), 20-year late mortality cumulative incidence was highest after HCT (13.9%; 95% confidence interval [CI], 10.0%-17.8%; chemo + CRT, 7.6%; 95% CI, 2.2%-13.1%; chemo-only, 5.1%; 95% CI, 2.8%-7.4%). Cumulative incidence of mortality for HCT survivors diagnosed in the 1990s (8.5%; 95% CI, 4.1%-12.8%) was lower vs those diagnosed in the 1970s (38.9%; 95% CI, 16.4%-61.4%). Most survivors did not experience any grade 3 to 5 CHC after 20 years (HCT, 45.8%; chemo + CRT, 23.7%; chemo-only, 27.0%). Furthermore, a temporal reduction in CHC cumulative incidence was seen after HCT (1970s, 76.1%; 1990s, 38.3%; P = .02), mirroring reduced use of total body irradiation. Self-reported health status was good to excellent for 88.2% of survivors; however, this was lower than that for siblings (94.8%; P < .0001). Although HCT is associated with greater long-term morbidity and mortality than chemotherapy-based treatment, gaps have narrowed, and all treatment groups report favorable health status.

Keywords

Humans, Child, Adult, Cancer Survivors, Outcome Assessment, Health Care, Myeloproliferative Disorders, Health Status, Leukemia, Myeloid, Acute, Chronic Disease

Published Open-Access

yes

Recommended Citation

Turcotte, Lucie M; Whitton, Jillian A; Leisenring, Wendy M; et al., "Chronic Conditions, Late Mortality, and Health Status After Childhood AML: A Childhood Cancer Survivor Study Report" (2023). Faculty, Staff and Student Publications. 3361.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/3361