Adolescent, young adult leukemia survivors have worse long-term survival outcomes than general population
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Survivors of adolescent and young-adult acute myeloid leukemia and acute lymphoblastic leukemia had lower long-term survival rates than the general population, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.
Researchers also observed disparities in long-term survival among this population based on age, sex and ethnicity.
Rationale and methods
Cure rates for adolescents and young adults (AYAs) diagnosed with cancer have increased during the past few decades; however, little is known about the long-term outcomes of these patients, Michael E. Roth, MD, associate professor and co-director of the adolescent and young adult oncology program, and director of the childhood cancer survivorship program at The University of Texas MD Anderson Cancer Center, told Healio.
“AYAs with leukemia receive intensive chemotherapy and many have an allogeneic stem cell transplant,” he added. “Many patients who receive these treatments experience serious and life-threatening long-term side effects and develop chronic health conditions. We sought to understand whether AYA leukemia survivors lived normal life spans and identify risk factors for having a shortened life span. It is important to note that these patients are diagnosed in their teenage years, 20s and 30s, and thus, potentially have another 50 to 70 years of life to be lived after their cancer diagnosis and treatment.”
The researchers examined data on 5-year survivors of AYA acute myeloid leukemia (AML; n = 1,938; median age at diagnosis, 28 years; 58% white) and acute lymphoblastic leukemia (ALL; n = 2,350; median age at diagnosis, 23 years; 59% white) included in the SEER database between 1975 and 2011.
They compared long-term survival rates with a U.S. National cohort obtained from the National Vital Statistics Report.
Median follow-up from diagnosis of ALL was 12.3 years and 12.7 years for those with AML.
Key findings
Results showed 10-year survival rates of 87% among ALL survivors, 89% among AML survivors and 99% for the general population. Differences persisted for up to 30 years of follow-up and leukemia remained the most common cause of death during the early survivorship period.
Researchers specifically observed worse survival among those diagnosed at older ages, with each additional year at diagnosis associated with a 6% decrease in long-term survival for ALL and a 5% decrease in survival for AML.
Moreover, male survivors of AML experienced significantly worse survival than females (survival time ratio = 0.61; 95% CI, 0.45-0.82). Asian or Pacific Islander survivors of ALL experienced longer survival compared with Hispanics. However, Hispanic survivors of ALL survived 56% as long as white survivors, but the difference did not reach statistical significance after researchers adjusted for socioeconomic status.
Overall long-term survival improved during the most recent decades of diagnosis, with the life span of those diagnosed during the 1990s and 2000s more than twofold longer than that of those diagnosed during the 1980s. Yet, researchers observed no additional improvements in long-term survival among those diagnosed in the 2000s vs. the 1990s for either ALL or AML.
“Some of these patients aren’t being fully cured of their initial cancer, so between 5 and 10 years after initial diagnosis, most deaths are associated with disease progression or relapse, whereas after that, most deaths result from late side effects of treatment, including cardiovascular disease and secondary cancers,” Roth said in a press release. “We think that we are likely to see much more progress in cure rates over the next 2 decades, in patients diagnosed from 2010 to 2020, due to newer immunotherapy and targeted agents being used more frequently for these patients.”
Researchers reported study limitations, including relative underrepresentation of racial/ethnic minorities, which may limit the ability to detect disparities in long-term survival among these patient populations. In addition, researchers could not capture the differences in survival based on socioeconomic status.
Implications
“AYA survivors of leukemia are at high-risk for early mortality. While intensive treatment is leading to more cures, this therapy is also likely leading to the development of many chronic health conditions,” Roth said. “While cure is still the most important outcome, long-term health and health-related quality of life needs to be considered as we treat patients during and after treatment. More attention is needed on providing patients access to long-term, high quality survivorship care.”
Further research should be conducted to understand why certain patient populations, such as males and racial/ethnic minorities, have a higher risk for early death, he added.
“We need to identify opportunities to intervene early to improve the long-term health of these patients,” Roth said. “This may include ensuring patients have lifelong access to preventive health care, undergo timely cancer screening and maximize their health by increasing exercise and improving their nutrition. AYA survivors need high-quality survivorship care and efforts are needed to ensure this survivorship care is accessible to all — regardless of age, sex, race, ethnicity or socioeconomic status.”
For more information:
Michael E. Roth, MD, can be reached at The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77479; email: mroth1@mdanderson.org.
References:
Adolescent and young adult leukemia survivors face higher mortality rates than the general population for decades after diagnosis (press release). https://www.eurekalert.org/news-releases/952547. Published May 13, 2022. Accessed May 13, 2022.
Berkman AM, et al. Cancer Epidemiol Biomarkers Prev. 2022;doi:10.1158/1055-9965.EPI-21-1388.
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Berkman AM, et al. Cancer Epidemiol Biomarkers Prev. 2022;doi:10.1158/1055-9965.EPI-21-1388.
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