Adolescent and young adult leukemia survivors

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Credit: Courtest of the AACR

PHILADELPHIA – The long-term survival of adolescent and young adult (AYA) survivors of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) was shorter than that of the general population, and the differences persisted until at 30 years after diagnosis, according to results published in Cancer epidemiology, biomarkers and preventiona journal of the American Association for Cancer Research.

“The number of AYAs diagnosed with acute leukemia who recover from their original cancer has increased,” said Michael Roth, MD, associate professor, co-director of the Adolescent and Young Adult Oncology (AYA) Program and director of the Childhood Program cancer survivorship at the University of Texas MD Anderson Cancer Center. “These patients potentially have five decades or more ahead of them beyond their cancer diagnosis. Therefore, it is not only important to cure them of their initial cancer, but also to consider their long-term lifespan and quality of life, to ensure that they live a long, healthy life. healthy and happy afterwards.

To understand the long-term survival outcomes of this patient population, Roth and colleagues used the Surveillance, Epidemiology, and End Results (SEER) database and analyzed mortality patterns among five-year survivors of the disease. ‘AYA ALL and AML. “We started our analysis five years after the initial diagnosis to separate out when patients were receiving very intensive treatment from when they were back in their lives but potentially experiencing late side effects from their initial treatment,” Roth said. .

The authors obtained information on 1,938 ALL survivors and 2,350 AML survivors for the years 1975 to 2011 and assessed differences in lifespan between ALL and AML cohorts and a US national cohort. obtained from national vital statistics report.

Among ALL survivors, 6% were black, 29% were Hispanic, 7% were Asian or Pacific Islander, and 58% were white. Among AML survivors, 9% were black, 22% were Hispanic, 10% were Asian or Pacific Islander, and 59% were white. The median age at diagnosis was 23 years for ALL and 28 years for AML. The median durations of follow-up from diagnosis were 12.3 and 12.7 years for ALL and AML, respectively.

The researchers found that the 10-year survival of AYA leukemia survivors was about 10% lower than that of the age-adjusted general US population, and the differences persisted up to 30 years of follow-up. “These patients go through so many challenges during their cancer treatment, and it also seems like they go through so many other challenges during their survival,” Roth said. “For example, the mortality of AML survivors continues to increase decades after treatment, most likely because the majority of these patients undergo stem cell transplantation, which is associated with very high risk and number of deaths. ‘late side effects.’

Leukemia remained the most common cause of death in the early survival period. “Some of these patients are not completely cured of their initial cancer, so between five and 10 years after the initial diagnosis, most deaths are due to disease progression or relapse, whereas after that, the most deaths result from late side effects of treatment, including cardiovascular disease and secondary cancers,” Roth said.

Older age at diagnosis was correlated with poorer long-term survival outcomes, with each additional year at diagnosis associated with a 6% and 5% decrease in long-term survival for survivors of ALL and LAM, respectively.

Patient gender was only associated with long-term outcomes for AML survivors, with men surviving 61% as long as women.

Among AYA ALL survivors, Asians or Pacific Islanders had longer survival than Hispanics. Hispanic individuals also tended to have a shorter survival time than non-Hispanic white individuals, surviving 56% as long as white survivors, although this difference did not reach statistical significance after adjusting for socioeconomic status. .

“Historically, patients from ethnic and racial minorities have had less access to quality health care, and we are concerned that they may receive less preventive health care to prevent secondary cancers and to treat some of the late cardiovascular effects that can occur after leukemia treatment,” Roth said.

The researchers found that long-term survival improved over the last decades of diagnosis, as people diagnosed in the 1990s and 2000s lived more than twice as long as those diagnosed in the 1990s. 1980. This was likely due to advances in treatment leading to better cure rates with lower toxicities and better supportive care.

However, there was no additional improvement in long-term survival for patients diagnosed in the 2000s compared to the 1990s for ALL or AML. “We think we are likely to see much more progress in cure rates over the next two decades, in patients diagnosed between 2010 and 2020, due to newer immunotherapy and targeted agents being used more frequently for these patients. .

“While we anticipate that we will see longer lasting cure rates with recent new treatments, it is unclear whether the number and intensity of late side effects will decrease,” Roth added.

“Registry studies are good at identifying trends and outcomes for a very large population, but they have some limitations,” Roth said. “Although we have established that AYA leukemia survivors have a shortened lifespan and we have information on the general causes of death of these patients, we do not know the details of their health since their diagnosis, their survival and their death. And that’s really the next step: we need to fill in the gaps to understand why these patients are dying and what we can do to intervene early to change these curves. »

Despite the study’s large sample size, racial/ethnic minorities were relatively underrepresented, which may limit the ability to detect disparities in long-term survival affecting these populations. The researchers were also unable to capture differences in survival based on socioeconomic status.

This study was funded by the National Cancer Institute of the National Institutes of Health, the Archer Foundation and LyondellBasell. The authors declare no conflict of interest.

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