Chronic conditions, late mortality, and health status after childhood AML: a Childhood Cancer Survivor Study report.

Autor:	Turcotte LM; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN., Whitton JA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA., Leisenring WM; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA., Howell RM; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX., Neglia JP; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN., Phelan R; Center for International Blood and Marrow Transplantation, Milwaukee, WI.; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI., Oeffinger KC; Department of Medicine, Duke University School of Medicine, Durham, NC., Ness KK; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN., Woods WG; Aflac Cancer Center, Children's Healthcare of Atlanta/Emory University, Atlanta, GA., Kolb EA; Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System, Wilmington, DE., Robison LL; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN., Armstrong GT; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN., Chow EJ; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Blood [Blood] 2023 Jan 05; Vol. 141 (1), pp. 90-101.
DOI:	10.1182/blood.2022016487
Abstrakt:	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. (© 2023 by The American Society of Hematology.)
Databáze:	MEDLINE
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