title: Outcome and late effects among acute myeloid leukemia survivors: a nationwide population-based study.
abstract: Understanding of pathogenesis and treatment for acute myeloid leukemia (AML) is growing. However, studies regarding the outcomes and late effects among AML survivors are relatively limited.
  
  
  
  This nationwide population-based study used medical records from the Taiwanese National Health Insurance Research Database. A total of 3356 AML patients diagnosed from 2000 to 2008 were analyzed. The physiological and psychological morbidities in AML survivors were compared to those identified from a normal population. This study also compared late effects among AML survivors treated by intensive chemotherapy alone and allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  
  The incidence of AML in Taiwan has increased from 1.07 per 100,000 persons in 2000 to 2.17 per 100,000 persons in 2008 (p < 0.0001). With the median overall survival (OS) time of 0.98 years, 25.0 % of AML patients in this study cohort received best supportive care alone. Compared to the normal population, AML survivors had higher rates of hypertension (hazard ratio [HR] 1.69; 95 % confidence interval [CI] 1.18-2.42; p < 0.01), cardiovascular disease (HR 2.53; 95 % CI 1.39-4.61; p < 0.01), diabetes (HR 2.27; 95 % CI 1.48-3.48; p < 0.001), and psychological disorders (HR 1.45; 95 % CI 1.04-2.04; p < 0.05). Although patients undergoing allo-HSCT had a better OS than did patients treated with intensive chemotherapy alone (median not reached vs. 1.53 years; p < 0.0001), diabetes was found more often among allo-HSCT recipients than among patients receiving intensive chemotherapy only (HR 2.93; 95 % CI 1.21-7.08; p < 0.05).
  
  
  
  Regular physical and psychological surveillance of AML survivors is needed especially for those receiving allo-HSCT.
authors: Department of Public Health, China Medical University, Taichung, Taiwan.
authors: Kuang-Hsi
authors: KH
authors: Chang
authors: Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
authors: Wen-Li
authors: WL
authors: Hwang
authors: School of Medicine, China Medical University, Taichung, Taiwan.|Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors: Chih-Hsin
authors: CH
authors: Muo
authors: Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. hsuc@mail.cmuh.org.tw.
authors: Chung Y
authors: CY
authors: Hsu
authors: Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. drteng@vghtc.gov.tw.|Department of Life Science, Tunghai University, Taichung, Taiwan. drteng@vghtc.gov.tw.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan. drteng@vghtc.gov.tw.
authors: Chieh-Lin Jerry
authors: CJ
authors: Teng
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute myeloid leukemia; Allogeneic hematopoietic stem cell transplantation; Diabetes; Overall survival; Survivorship