Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study

Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Blood (Impact Factor: 10.45). 06/2008; 111(12):5515-23. DOI: 10.1182/blood-2007-10-117150
Source: PubMed


Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for late effects of cancer therapy. Five-year ALL survivors (< 21 years at diagnosis; n = 5760 eligible, 4151 participants), diagnosed from 1970 to 1986 were compared with the general population and a sibling cohort (n = 3899). Cumulative mortality of 5760 5-year survivors was 13% at 25 years from diagnosis. Recurrent ALL (n = 483) and second neoplasms (SNs; n = 89) were the major causes of death. Among 185 survivors, 199 SNs occurred, 53% in the CNS. Survivors reported more multiple chronic medical conditions (CMCs; odds ratio [OR], 2.8; 95% CI, 2.4-3.2) and severe or life-threatening CMCs (OR, 3.6; 95% CI, 3.0-4.5) than siblings. Cumulative incidence of severe CMCs, including death, 25 years from diagnosis was 21.3% (95% CI, 18.2-24.4; 23.3% [95% CI, 19.4-27.2] and 13.4% [95% CI, 8.4-18.4] for irradiated and nonirradiated survivors, respectively). Survivors reported more adverse general and mental health, functional impairment, and activity limitations compared with siblings (P < .001). Rates of marriage, college graduation, employment, and health insurance were all lower compared with sibling controls (P < .001). Long-term survivors of childhood ALL exhibit excess mortality and morbidity. Survivors who received radiation therapy as part of their treatment or had a leukemia relapse are at greatest risk for adverse outcomes.


Available from: Wendy Leisenring
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    ABSTRACT: Childhood cancer incidence in Suriname (South-America) was estimated using secondary data from 1980 to 2008, and these findings were stratified according to gender; age groups < 1, 1-4, 5-14, and 15-19 years; and the largest ethnic groups (Hindustanis, Maroons, Creoles, and Javanese). Data were expressed as total numbers, proportions, average yearly numbers, and/or crude incidence rates per 1,000,000 population per year. There were 290 malignancies in the period covered, i.e., about 10 new cases per year or 24 per 1,000,000 per year. The average yearly number of overall cancer increased from approximately 1 every two years in newborns to 3-4 per year in adolescents and young adults. Thirty to 35% of patients were Hindustani or Creole; the proportions of Javanese and Maroons patients were about twice and five times, respectively, lower. Leukemias and lymphomas comprised almost half of cases, each occurring 2 to 3 times per year. Bone tumors, soft-tissue sarcomas, and carcinomas were the most common non-hematological malignancies, occurring once or twice per year. Central nervous system tumors, neuroblastoma, retinoblastoma, renal tumors, primary hepatic tumors, and germ cell tumors were exceedingly rare. In conclusion, childhood cancer incidence in Suriname was relatively low; the individual histiotypes displayed an unusual ranking; and there were differences in the sex, age, and ethnic distribution of overall cancer as well as certain histiotypes. However, these observations might be biased by the use of crude rates, and underdiagnosis and incomplete registration of cases due to the absence of specialized (pediatric) cancer facilities in the country.
    The Open Epidemiology Journal 07/2014; 7(1):27-36. DOI:10.2174/1874297120140701004
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    • "The main finding of our study that there is no increased risk of hospital contacts of non-irradiated survivors of ALL is supported by the CCSS study where the vast majority (92%) of the non-irradiated, non-relapsed survivors did not report any severe chronic medical condition [24]. On the basis of the results of the present study, follow-up of ALL survivors should primarily focus on developing preventive interventions, and enhancing patient counseling and follow-up care of those whose treatment included irradiation. "
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    ABSTRACT: Background Previous studies have indicated that survivors of childhood acute lymphoblastic leukemia (ALL) have an increased morbidity measured in terms of health care utilization. However, earlier studies have several potentially important limitations. To overcome some of these, we investigated hospital contact rates, and predictors thereof, among 5-year survivors of ALL in a population-based setting, and compared them to a control cohort regarding outcome measures from a comprehensive nation-wide health register. Methods All individuals diagnosed with ALL before the age of 18 in Southern Sweden during 1970–1999 and alive January 2007 (n = 213; male = 107) were identified through the Swedish Cancer Register. Each subject was matched to fifty controls, identified in the Swedish Population Register. All study subjects were linked to the National Hospital Register and detailed information was obtained on all hospital contacts (hospital admissions and outpatients visits) starting five years after cancer diagnosis, and the corresponding date for the controls, until 2009. Results The median follow-up among the 5-year survivors of ALL was 16 years (range 5–33), accruing a total of 3,527 person-years. Of the 213 5-year survivors, 105 (49.3%) had at least one hospital contact compared to 3,634 (34.1%) of the controls (p < 0.001). Survivors had more hospital contacts (3 [1–6] vs. 2 [1–4] contacts, p < 0.001) and more total days in hospital (6 [2–18] vs. 3 [1–7] days, p < 0.001) than the controls during the study period. Logistic regression analysis showed that survivors treated with cranial irradiation and/or total body irradiation (45% and 7%, respectively) had an increased risk of at least one hospital contact (OR 2.3, 95%CI; 1.5–3.6 and OR 11.0, 95%CI; 3.2–50.7, respectively), while there was no significant difference between the non-irradiated survivors and controls. Conclusions We show that irradiated survivors of childhood ALL have an increased morbidity measured in terms of hospital contacts, in comparison to non-irradiated survivors and controls, while non-irradiated survivors have not. These findings are encouraging regarding the future morbidity of children currently treated for ALL, as radiotherapy is necessary only for a minority of these.
    BMC Cancer 06/2014; 14(1):419. DOI:10.1186/1471-2407-14-419 · 3.36 Impact Factor
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    • "Childhood ALL (acute lymphoblastic leukaemia) is cured in ,80– 90% of the patients, but a significant number of survivors suffer from chemotherapy-induced side effects (Mody et al., 2008). These can appear during treatment or become clinically evident years after therapy. "
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    Cell Biology International 09/2011; 36(1):79-86. DOI:10.1042/CBI20110264 · 1.93 Impact Factor
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