"AYA survivors treated for leukemia are at high risk for early mortality," Dr. Michael Roth of the University of Texas MD Anderson Cancer Center in Houston told Reuters Health by email. "While intensive treatment has led to more cures, this therapy is also likely leading to the development of many chronic serious health conditions later in life."
"While cure is still the most important outcome, long-term health and health-related quality of life needs to be strongly considered as we treat patients during and after treatment," he said. "More attention is needed on providing patients access to long-term, high quality survivorship care, regardless of age, sex, race, ethnicity or socioeconomic status."
As reported in Cancer Epidemiology, Biomarkers and Prevention, Dr. Roth and colleagues analyzed SEER registry data to assess long-term outcomes of AYA acute leukemia five-year survivors and the impact of age at diagnosis, sex, race/ethnicity, socioeconomic status, and decade of diagnosis.
The study included data on AYA leukemia survivors diagnosed between 1980 and 2009, including 1,938 patients with ALL and 2,350 with AML.
Among ALL survivors, the mean age at diagnosis was 23; 38% were women; 58%, white; 29%, Hispanic; 7%, Asian or Pacific Islander, and.6%, Black. Among AML survivors, the mean age at diagnosis was 28; 52% were women; 59%, white; 22%, Hispanic; 10%. Asian or Pacific Islander; and, and 9%, Black. The median follow-up was 12.3 and 12.7 years, respectively.
Survival was compared with a U.S. age-adjusted general population cohort.
Ten-year survival for ALL was 87%; for AML survivors, 89%; and for the general population, 99%. Survival for AYA leukemia survivors remained below that of the age-adjusted general population at up to 30 years of follow-up.
The primary cancer was the most common cause of death in early survivorship; noncancer death causes became more prevalent in later decades of follow-up. Dr. Roth explained, "In the early years of survivorship (5-10 years after diagnosis) the most common cause of death is recurrence of their cancer, while later on the most common causes of early death include cardiovascular disease and subsequent cancers, likely due to their cancer treatment."
Older age at diagnosis correlated with worse long-term survival outcomes; each additional year at diagnosis was associated with a 6% decrease in long-term survival for ALL and 5% decrease for AML.
Male AML survivors had significantly worse survival than females (survival time ratio: 0.61), whereas Asian or Pacific Islanders AYA ALL survivors had longer survival than Hispanics.
Dr. Roth said, "We are developing new cohort studies to identify when patients develop serious chronic health conditions after treatment, track their access to and utilization of preventative health care, and identify barriers to receipt of survivorship care."
Dr. Henry Fung, who chairs the Department of Bone Marrow Transplant and Cellular Therapies at Fox Chase Cancer Center in Philadelphia, commented on the study in an email to Reuters Health. "While we are celebrating long-term remission for many of our leukemia patients," he said, "we are reminded by this publication that many of them will have a shortened life and are facing many challenges in their life physically and psychologically secondary to their leukemia and treatment."
"Researchers and clinicians are working hard to decrease treatment-related toxicity, though this will not help our current leukemia survivors," he noted. "Active surveillance is required for all of them, and a cure should be defined as return to normal life, not just in remission."
"In this report, the researchers focus on AYA, though our adult leukemia survivors and all cancer survivors are subject to the same challenges, if not more," Dr. Fung concluded.
SOURCE: https://bit.ly/3MSu252 Cancer Epidemiology, Biomarkers and Prevention, online May 13, 2022.
By Marilynn Larkin
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