Adolescent and Young Adult ALL and AML Survivors Exhibit Worse Long-Term Survival vs General Population

Leukemia survivors who were adolescents or young adults had worse long-term survival outcomes vs the general population.

Adolescents and young adult acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) survivors were found to have higher mortality rates than the general population that persists for decades following diagnosis, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.1

The 10-year survival for patients with ALL and AML was 87% and 89% for younger patients, respectively, vs 99% for the general population. The difference in survival persisted at up to 30 years of follow-up. For patients with ALL and AML, the 10-year survival 83% vs 82% for those diagnosed in the 1980s, 88% vs 90% in the 1990s, and 88% vs 90% in the 2000s, respectively. The most common cause of death was acute leukemia, but after 10 years post-diagnosis, this plateaued for both groups. However, deaths due to subsequent malignancies and cardiac disease continued to climb.

“The number of [adolescent and young adults] diagnosed with acute leukemia who are being cured from their initial cancer has increased,” Michael 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, said in a press release.2 “These patients have potentially 5 or more decades of life ahead of them, beyond their cancer diagnosis. Therefore, it is not just important to cure them of their initial cancer, but also to consider their long-term lifespan and quality of life, to make sure they are living long, healthy, and happy lives afterward.”

A total of 1938 patients with acute lymphoblastic leukemia (ALL) and 2350 patients with acute myeloid leukemia (AML) who were all 5-years survivors were included in the study. In the ALL and AML groups, respectively, 6% vs 9% of patients were Black, 29% vs 22% were Hispanic, 7% vs 10% were Asian or Pacific Islanders, and 58% vs 59% were White. The median age at the time of diagnosis for those ALL survivors was 23 years and 28 years for AML survivors. The median follow-up was 7.3 years for ALL survivors and 7.7 years for AML survivors.

The covariate-adjusted models showed that age at diagnosis played a significant role in long-term survival (P <.0001), with a 6% decrease with each additional year at diagnosis for ALL survivors and 5% for AML. Patients who were male with AML had significantly worse survival than female patients (P <.0001). Sixty-one percent of male patients survived as long as female patients (survival time ratios [STR], 0.61; 95% CI, 0.45-0.82). Investigators did not find a survival difference for those with ALL (ST, 0.96; 95% CI, 0.62-1.49).

Patients who were Asian or Pacific Islanders with ALL had better survival than those who were Hispanic with ALL (unadjusted P = .009; Tukey P = .047; STR = 3.77; 95% CI, 1.39-10.28). Additionally, Hispanic ALL survivors had a lower survival than those who were White (unadjusted P = .036; Tukey P = .15; STR = 0.56; 95% CI, 0.32-0.96).

When investigating patients’ socioeconomic status and survival, no correlation impacting long-term survival was identified. Patients who lived in rural areas did not have their long-term survival impacted.

The long-term survival of a patients diagnosed in the 1990s was almost twice that of those who were diagnosed in the 1980s with ALL (unadjusted P = .008; Tukey P = .021; STR = 2.62; 95% CI, 1.29-5.31) and AML (unadjusted P = .0002; adjusted P = .0007; STR = 2.18; 95% CI, 1.44-3.29). Survival for those diagnosed in the 2000s was doubled compared with those diagnosed in the 1980s with ALL (unadjusted P = .009; Tukey P = .025; STR = 2.37; 95% CI, 1.24-4.55) and AML (unadjusted P = .0003; Tukey P = .0008; STR = 2.17; 95% CI, 1.43-3.30). No long-term survival differences were identified for those diagnosed in the 2000s compared with the 1990s.

References

  1. Berkman AM, Andersen CR, Cuglievan B, et al. Long-term outcomes among adolescent and young adult (AYA) survivors of acute leukemia: a surveillance, epidemiology, and end results (SEER) analysis. Cancer Epidemiol Biomarkers Prev. Published Online May 13, 2022. doi.10.1158/1055-9965.EPI-21-1388
  2. Adolescent and young adult leukemia survivors face higher mortality rates than the general population for decades after diagnosis. News Release. American Association for Cancer Research. May 13, 2022. Accessed May 13, 2022. https://bit.ly/3las4AWt.ly/3las4AW