title: Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.
abstract: 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.
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, USA.
authors.forename: Rajen
authors.initials: R
authors.lastname: Mody
authors.forename: Suwen
authors.initials: S
authors.lastname: Li
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Dover
authors.forename: Stephen
authors.initials: S
authors.lastname: Sallan
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D008297:Male; D008393:Marriage; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis