title: Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: a report from the Childhood Cancer Survivor Study.
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 < or =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 > or =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 > or =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.
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, MN 55455, USA. mulro006@umn.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mulrooney
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Dover
authors.forename: Suwen
authors.initials: S
authors.lastname: Li
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D008393:Marriage; D008875:Middle Aged; D015996:Survival Rate; D017741:Survivors