Researchers at the University of Texas MD Anderson Cancer Center have found that adolescent and young adult (AYA) cancer survivors with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) have higher rates of reduced long-term survival compared to their cancer-free peers. The study also found that the lower long-term mortality outcomes persist for up to three decades after survival.
The findings, published today in Cancer Epidemiology, Biomarkers & Prevention, suggest that there is a critical data monitoring gap that needs to be addressed to better understand what is impacting the long-term survival of AYAs.
“We have to think about the long-term lifespan and quality of life of our patients. The cure is not enough for our AYA cancer survivors,” said Michael Roth, MD, associate professor of pediatric patient care and director of the Childhood Cancer Survivorship Clinic. “Once these patients reach the survival stage of their journey, they may experience additional side effects due to intensive treatment, lack of access to quality health care, and other issues that can have a negative impact on their overall health and survival.”
AML and ALL are two of the most common leukemias diagnosed in AYAs between the ages of 15 and 39. The incidence of all cancers in the AYA population has increased by 30% over the past 50 years, although survival rates have also improved for all cancers affecting this age group. Yet cancer survivors are generally at higher risk of developing serious health problems because of the treatments they receive.
In order to focus on specific survival disparities and learn about patient outcomes after surviving their initial diagnosis, researchers analyzed data from cancer survivors who were at least five years post-treatment.
Roth and his team used data from the Surveillance, Epidemiology, and End Results (SEER) program to examine the long-term survival outcomes of 1,938 AML and 2,350 ALL survivors diagnosed between 1975 and 2011. The demographic distribution of LAL survivors were 6% Black, 7% Asian or Pacific Islander, 29% Hispanic, and 58% White, while AML survivors were 9% Black, 10% D ‘Asian or Pacific Islander, 22% Hispanic and 59% White. Data studied included age, sex, and decade of diagnosis for each group of survivors. The SEER data was then compared to data from the US general population cohort.
Among the patients surveyed, the mean age of diagnosis for ALL and AML survivors was 23 and 28 years, respectively. The 10-year survival rate of AYA in the general population was about 10% higher than that of AML and ALL survivors. Long-term survival has improved in recent decades.
“During the previous decades, many more patients saw their disease reappear after a few years and they were not really cured of their initial cancer. We’ll likely see more progress over the next decade or two as the data continues to mature,” said Roth, who is also co-director of MD Anderson’s AYA Oncology Program. “Most of the improvements will be due to new immunotherapies and targeted agents that change the standard of care for patients.”
Other key data from the study showed no evidence of a difference in survival between male and female ALL survivors, but male AML survivors lived only 61% as long as females. Additionally, other data suggests that men have twice the risk of heart disease as well as other health conditions, which can make the problem worse.
Hispanics and blacks also had lower 10-year survival rates after diagnosis compared to other groups. In general, minorities have been associated with a higher risk of disease, more intensive therapy, poorer short-term outcomes, and a higher risk of late side effects.
“Differences between male and female survival rates may be related to the fact that male survivors potentially have less medical follow-up than female survivors; and minority groups may have less access to quality health care and ultimately less preventive care,” Roth said. “Having access to more detailed socio-economic data on survivors could also help provide a more accurate assessment of outcomes that impact the data.”
Although leukemia is still the most common cause of death for this group after five years, mortality beyond 10 years is most likely attributed to secondary or late side effects, cardiovascular disease, or secondary cancer. Roth also noted that most patients diagnosed with leukemia will at some point require a stem cell transplant, which can lead to the development of serious chronic health conditions.
“The National Registry data used for this study gave us insight into some possible challenges that AML and ALL patients may experience throughout survival, but we need to investigate their journey in more detail,” Roth said. “A review of their socioeconomic status, comorbidities, access to quality health care, and other risk factors that may affect their survival is warranted.”
Roth suggested that future research on AYA survivors of AML and ALL could mirror work currently being done on survivors of Hodgkin’s lymphoma, including efforts to limit treatment side effects by focusing on less as well as incorporating exercise and nutrition into the early stages of survivorship care.
This research was supported by the National Cancer Institute of the National Institutes of Health (P30 CA016672; R38-HL143612), the Archer Charitable Foundation and LyondellBasell. The authors have no conflict of interest. A full list of collaborating researchers is included in the document.