Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: A report from the Childhood Cancer Survivor Study

Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 12/2006; 24(33):5277-82. DOI: 10.1200/JCO.2006.07.2884
Source: PubMed

ABSTRACT This report examines the incidence of and risk factors for strokes that occur in > or = 5-year survivors of childhood leukemia and brain tumors.
The rate of first occurrence of self-reported late-occurring strokes was determined for leukemia survivors (n = 4,828), brain tumor survivors (n = 1,871), and a comparison group of a random sample of cancer survivor siblings (n = 3,846). Relative risks (RRs) and 95% confidence intervals (CIs) of stroke by treatment exposures were examined by multivariate analyses.
Thirty-seven leukemia survivors and 63 brain tumor survivors reported a late-occurring stroke. The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 person-years (95% CI, 41.2 to 78.7). The RR of stroke for leukemia survivors compared with the sibling comparison group was 6.4 (95% CI, 3.0 to 13.8; P < .0001). The rate of late-occurring stroke for brain tumor survivors was 267.6 per 100,000 person-years (95% CI, 206.8 to 339.2). The RR of stroke for brain tumor survivors compared with the sibling comparison group was 29.0 (95% CI, 13.8 to 60.6; P < .0001). Mean cranial radiation therapy (CRT) dose of > or = 30 Gy was associated with an increased risk in both leukemia and brain tumor survivors in a dose-dependent fashion, with the highest risk after doses of > or = 50 Gy CRT.
Survivors of childhood leukemia and brain tumors, particularly those with brain tumors treated with CRT at doses of greater than 30 Gy, are at an increased risk of stroke.

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    • "Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and adult survivors of childhood-onset ALL account for about 28% of the Childhood Cancer Survival Study cohort [1]. Among survivors of childhood leukemia (ALL in about 90%), the relative hazard of congestive heart failure, myocardial infarction and late-occurring stroke was increased 4.2-fold, 3.3-fold and 6.4-fold, respectively, with the reference to the sibling control groups [3] [4]. Additionally, in ALL survivors standardized CV mortality ratio was elevated 4.2-fold compared with the age-, sex-and year-matched US population [1]. "
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