Contemporary survivors of childhood acute lymphoblastic leukemia (ALL) have reduced late morbidity and mortality, according to a study published online July 24 in the Journal of Clinical Oncology.
Stephanie B. Dixon, M.D., M.P.H., from St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues examined all-cause and health-related late mortality, subsequent malignant neoplasms (SMNs), chronic health conditions, and neurocognitive outcomes among 6,148 survivors of childhood ALL diagnosed between 1970 and 1999. Six groups of therapy combinations and treatment intensity were defined: 1970s-like (70s), standard- or high-risk 1980s-like and 1990s-like (90sSR, 90sHR), and relapse/transplantation.
The researchers found that the 20-year all-cause late mortality was 6.6 percent overall. Lower health-related late mortality was seen for 90sSR and 90sHR compared with 70s (rate ratio: 0.2 and 0.3), comparable with the U.S. population. 90sSR had a lower rate of SMN compared with 70s (rate ratio, 0.3), which was similar to that of the U.S. population. The 90sSR group also had fewer severe chronic health conditions (20-year cumulative incidence, 11 versus 22.5 percent) and a lower prevalence of impaired memory and task efficiency (prevalence ratios, 0.7 and 0.5) compared with the 70s.
“Taken together, these results demonstrate that the goal of risk-stratified therapy for children with standard-risk ALL, to reduce late morbidity and mortality while maintaining excellent outcomes, has been realized,” the authors write.
Several authors disclosed ties to the pharmaceutical and medical device industries.