Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia

A report from the Childhood Cancer Survivor Study

Authors

  • Daniel A. Mulrooney MD, MS,

    Corresponding author
    1. Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, Minnesota
    • Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, University of Minnesota, 420 Delaware Street SE, MMC 484, Minneapolis, MN 55455
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    • Fax: (612) 626-2815

  • Douglas C. Dover MSc,

    1. Department of Public Health Sciences, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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  • Suwen Li MSc,

    1. Department of Public Health Sciences, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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  • Yutaka Yasui PhD,

    1. Department of Public Health Sciences, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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  • Kirsten K. Ness PhD,

    1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Ann C. Mertens PhD,

    1. Department of Pediatrics, Emory University, Atlanta, Georgia
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  • Joseph P. Neglia MD, MPH,

    1. Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, Minnesota
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  • Charles A. Sklar MD,

    1. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Leslie L. Robison PhD,

    1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Stella M. Davies MBBS, PhD, MRCP,

    1. Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • and the Childhood Cancer Survivor Study

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    • List of CCSS institutions and investigators: Leslie L. Robison, PhD, Melissa Hudson, MD, Greg Armstrong, MD (St. Jude Children's Research Hospital, Memphis, Tenn); Joanna Perkins, MD, Maura O'Leary, MD (Children's Health Care Minneapolis, Minneapolis, Minn); Debra Friedman, MD, MPH, Thomas Pendergrass, MD (Children's Hospital and Medical Center, Seattle, Wash); Brian Greffe, MD, Lorrie Odom, MD (Children's Hospital, Denver, Colo); Kathy Ruccione, RN, MPH (Children's Hospital, Los Angeles, Calif); John Mulvihill, MD (Children's Hospital, Okalahoma City, Okla); Jill Ginsberg, MD, Anna Meadows, MD, Jean Tersak, MD, A. Kim Ritchey, MD (Children's Hospital of Pittsburgh, Pittsburgh, Pa); Julie Blatt, MD, Gregory Reaman, MD, Roger Packer, MD (Children's National Medical Center, Washington, DC); Stella Davies, MD, PhD (Cincinnati Children's Hospital Medical Center, Cincinnati, Oh); Smita Bhatia, MD, Stephen Qualman, MD, Sue Hammond, MD (City of Hope Hospital, Los Angeles, Calif); Amanda Termuhlen, MD, Frederick Ruymann, MD, (Columbus Children's Hospital, Columbus, Oh); Lisa Diller, MD, Holcombe Grier, MD, Frederick Li, MD (Dana-Farber Cancer Institute, Boston, Mass); Lillian Meacham, MD, Ann Mertens, PhD (Emory University, Atlanta, Ga); Wendy Leisenring, ScD, John Potter, MD, PhD (Fred Hutchinson Cancer Research Center, Seattle, Wash); Mark Greenberg, MBChB, Paul C. Nathan, MD (Hospital for Sick Children, Toronto, Ontario); John Boice, ScD (International Epidemiology Institute, Rockville, Md); Vilmarie Rodriguez, MD, W. Anthony Smithson, MD, Gerald Gilchrist, MD (Mayo Clinic, Rochester, Minn); Charles Sklar, MD, Kevin Oeffinger, MD (Memorial Sloan-Kettering Cancer Center New York, NY); Jerry Finklestein, MD (Miller Children's Hospital); Barry Anderson, MD, Peter Inskip, ScD (National Cancer Institute, Bethesda, Md); Terry A. Vik, MD, Robert Weetman, MD (Riley Hospital for Children, Indianapolis, Ind); Daniel M. Green, MD (Roswell Park Cancer Institute, Buffalo, NY); Robert Hayashi, MD, Teresa Vietti, MD (St. Louis Children's Hospital, Mo); Neyssa Marina, MD, Sarah S. Donaldson, MD, Michael P. Link, MD (Stanford University School of Medicine, Stanford, Calif); Zoann Dreyer, MD (Texas Children's Hospital, Houston, Tex); Kimberly Whelan, MD, MSPH, Jane Sande, MD, Roger Berkow, MD (University of Alabama, Birmingham, Ala); Yutaka Yasui, PhD (University of Alberta, Edmonton, Alberta); Jackie Casallis, MD, Lonnie Zeltzer, MD (University of California at Los Angeles, Los Angeles, Calif); Robert Goldsby, MD, Arthur Ablin, MD (University of California at San Francisco, San Francisco, Calif); Raymond Hutchinson, MD (University of Michigan, Ann Arbor, Mich); Joseph Neglia, MD, MPH (University of Minnesota, Minneapolis, Minn); Dennis Deapen, DrPH (University of Southern California, Los Angeles, Calif); Norman Breslow, PhD (University of Washington, Seattle, Wash); Dan Bowers, MD, Gail Tomlinson, MD, George R. Buchanan, MD (University of Texas Southwestern Medical Center at Dallas, Tex); Louise Strong, MD, Marilyn Stovall, MPH, PhD (The University of Texas M. D. Anderson Cancer Center, Houston, Tex).


  • This research made use of the Childhood Cancer Survivor Study (CCSS), a resource that is supported by the National Cancer Institute to promote and facilitate research on long-term survivors of cancer diagnosed in childhood and adolescence. Investigators may apply to use the CCSS by proposing an analysis of existing data or by proposing new initiatives that would use the cohort. Interested investigators are encouraged to visit the CCSS website at www.stjude.org/ccss to learn more about this unique resource.

Abstract

BACKGROUND

Limited data exist on the comprehensive assessment of late medical and social effects experienced by survivors of childhood and young adult acute myeloid leukemia (AML).

METHODS

This analysis included 272 5-year AML survivors who participated in the Childhood Cancer Survivor Study (CCSS). All patients were diagnosed at age ≤21 years between the years 1970 and 1986, and none underwent stem cell transplantation. Rates of survival, relapse, and late outcomes were analyzed.

RESULTS

The average follow-up was 20.5 years (range, 5–33 years). The overall survival rate was 97% at 10 years (95% confidence interval [95%CI], 94%–98%) and 94% at 20 years (95% CI, 90%–96%). Six survivors reported 8 recurrences. The cumulative incidence of recurrent AML was 6.6% at 10 years (95% CI, 3.7%–9.6%) and 8.6% at 20 years (95% CI, 5.1%–12.1%). Ten subsequent malignant neoplasms (SMN) were reported, including 4 with a history of radiation therapy, for a 20-year cumulative incidence of 1.7% (95% CI, 0.02%–3.4%). Six cardiac events were reported, for a 20-year cumulative incidence 4.7% (95% CI, 2.1%–7.3%). Half of the survivors reported a chronic medical condition and, compared with siblings, were at increased risk for severe or life-threatening chronic medical conditions (16% vs 5.8%; P < .001). Among those aged ≥25 years, the age-adjusted marriage rates were similar among survivors and the general United States population (57% for both) and lower compared with siblings (67%; P < .01). Survivors' college graduation rates were lower compared with siblings but higher than the general population (40% vs 52% vs 34%, respectively; P < .01). Employment rates were similar between survivors, siblings, and the general population (93%, 97.6%, and 95.8%, respectively).

CONCLUSIONS

Long-term survival from childhood AML ≥5-years after diagnosis was favorable. Late-occurring medical events remained a concern with socioeconomic achievement lower than expected within the individual family unit, although it was not different from the general United States population. Cancer 2008. © 2008 American Cancer Society.

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