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Children With Leukemia Living Longer...
More than 90 percent of children and young adults who survive five years or longer after diagnosis and treatment for acute myeloid leukemia (AML) are alive 20 years later and leading productive lives, according to a University of Minnesota study.
On a cautionary note, the study reports these survivors need to be regularly
evaluated and treated for health problems that may occur later in life as
a result of their initial cancer and its treatment.
These are the main findings of the first comprehensive study to analyze 20 years
of follow-up on survivors who were diagnosed and treated for AML as children
and young adults. Daniel Mulrooney, M.D., a pediatric oncologist and researcher
at the University of Minnesota Medical School and Cancer Center, led the research
team on this study. He reported the findings at the 48th annual meeting of the
American Society of Hematology (ASH) in Orlando, Fla. (Abstract # 560) "The
favorable survival rates indicate the tremendous progress that has been made
in the diagnosis and treatment of AML in children and young adults," says
Mulrooney. "However, health issues occurring later in life remain an area
of concern. It is crucial that these survivors continue to be evaluated in a
long-term, follow-up clinic where a physician familiar with the unique issues
of cancer survivors can review their previous treatment and screen for late effects
of that treatment."
Leukemias are the most common cancer affecting children and young adults. AML,
a cancer of the blood and bone marrow, accounts for about 25 percent of all childhood
leukemias. Significant research advances at the University of Minnesota and other
cancer centers over the past 30 years have resulted in better treatments and
dramatically improved survival rates. But limited information exists about the
medical and social outcomes of the children and young adults aggressively treated
for AML.
The University of Minnesota study is the first to analyze, over the long term,
the survival, medical late effects, marriage, education, and employment rates
of AML survivors compared to a control group of their siblings. Mulrooney and
his colleagues evaluated 272 AML survivors enrolled in the Childhood Cancer Survivor
Study (CCSS).
All of the survivors evaluated had survived at least five years from the time
of their diagnosis. They were younger than 21 years of age when diagnosed, were
treated between 1970-1986, and did not receive a blood or bone marrow transplant.
Fifty-six percent of the survivors had received only chemotherapy treatment,
and 34 percent were treated with both chemotherapy and radiation.
Among these survivors, 97 percent were living 10 years after their treatment
for AML, and 94 percent were living 20 years later. Six survivors reported recurrences
of AML. Two survivors died from the disease, one from congestive heart failure,
and one from a heart attack. The rate of AML recurrence was 1.8 percent at 10
years and 3.7 percent at 20 years.
As for their social, education, and employment outcomes, the study found:
* Marriage rates among AML survivors 25 years of age and older were similar to
the general U.S. population at 57 percent, but lower than the sibling group at
67 percent.
* 40 percent of the AML survivors graduated from college compared to 52 percent
of siblings and 34 percent of the general U.S. population.
* 93 percent of the survivors and 98 percent of the siblings were employed, and
92 percent of the survivors reported having health insurance compared to 89 percent
of the siblings.
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Mulrooney is also medical director of the University's Long-Term Follow-Up Clinic.
He worked with these colleagues to conduct this study: Douglas C. Dover, MSc.,
Suwen Li, M.S., and Yutaka Yasui, Ph.D., University of Alberta in Canada; Kirsten
Ness, Ph.D., Ann Mertens, Ph.D., and Joseph Neglia, M.D., University of Minnesota
in Minneapolis; Charles A. Sklar, M.D., Memorial Sloan-Kettering Cancer Center
in New York; Leslie L. Robison, Ph.D., St. Jude Children's Research Hospital,
Memphis, Tenn; and Stella Davies, M.D., Ph.D., Cincinnati Children's Hospital
Medical Center, Cincinnati, Ohio.
This study was funded by the National Cancer Institute, The American Lebanese
Syrian Associated Charities (ALSAC) support to St. Jude Children's Research Hospital,
and The Children's Cancer Research Fund support to the University of Minnesota
Cancer Center.
Contact: Sara E. Buss
University of Minnesota
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