BACKGROUND: Prior studies have identified that survivors of childhood acute lymphoblastic leukemia (ALL) report poor health status. It is unknown how risk-stratified therapy impacts the health status of ALL survivors.
METHODS: We estimated and compared the prevalence of self-reported poor health status among adult (≥18 years) survivors of childhood ALL diagnosed at age <21 years from 1970 to 1999 and sibling controls, excluding proxy reports. Therapy combinations defined treatment groups representative of 1970s therapy ( 70s), standard- and high-risk 1980s and 1990s therapy ( 80sSR, 80sHR, 90sSR, 90sHR), and relapse/bone marrow transplant ( R/BMT). Log-binomial models, adjusted for clinical and demographic factors, compared outcomes between groups using prevalence ratios (PR) with 95% confidence intervals (CI).
RESULTS: Among 5,119 survivors and 4,693 siblings, survivors were more likely to report poor health status in each domain including poor general health (13.5% vs. 7.4%; PR = 1.92; 95% CI, 1.69-2.19). Compared with 70s, 90sSR and 90sHR were less likely to report poor general health ( 90sSR: PR = 0.75; 95% CI, 0.57-0.98; 90sHR: PR = 0.58; 95% CI, 0.39-0.87), functional impairment ( 90sSR: PR = 0.56; 95% CI, 0.42-0.76; 90sHR: PR = 0.63; 95% CI, 0.42-0.95), and activity limitations ( 90sSR: 0.61; 95% CI, 0.45-0.83; 90sHR: PR = 0.59; 95% CI, 0.38-0.91). An added adjustment for chronic conditions in multivariable models partially attenuated 90sSR risk estimates.
CONCLUSIONS: Risk-stratified ALL therapy has succeeded in reducing risk for poor general health, functional impairment, and activity limitations among more recent survivors of standard- and high-risk therapy.
IMPACT: Future research into the relationship between risk-stratified therapy, health status, and late health outcomes may provide new opportunities to further improve late morbidity among survivors.
|Original language||English (US)|
|Number of pages||11|
|Journal||Cancer Epidemiology Biomarkers and Prevention|
|State||Published - Jan 2022|
Bibliographical noteFunding Information:
This research was supported by research funding from the NCI (CA55727, to G.T. Armstrong, Principal Investigator). Support to St. Jude Children’s Research Hospital also provided by the Cancer Center Support (CORE) grant (CA21765, to C. Roberts, Principal Investigator) and the American Lebanese-Syrian Associated Charities (ALSAC).
S.B. Dixon reports grants from NCI during the conduct of the study. C.-H. Pui reports grants from NCI during the conduct of the study as well as other support from Adaptive Biotechnology, Novartis, and Amgen outside the submitted work. S.P. Hunger reports other support from Amgen and personal fees from Amgen and Servier outside the submitted work. L.B. Silverman reports personal fees from Jazz Pharmaceuticals and Servier Pharmaceuticals outside the submitted work. K.K. Ness reports grants from NIH during the conduct of the study. K.R. Krull reports grants from NCI during the conduct of the study. G.T. Armstrong reports grants from NIH during the conduct of the study. No disclosures were reported by the other authors.
© 2022 American Association for Cancer Research Inc.. All rights reserved.
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Research Support, N.I.H., Extramural