Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: A report from the Childhood Cancer Survivor Study

Daniel A. Mulrooney, Douglas C. Dover, Suwen Li, Yutaka Yasui, Kirsten K. Ness, Ann C. Mertens, Joseph P. Neglia, Charles A. Sklar, Leslie L. Robison, Stella M. Davies, Melissa Hudson, Greg Armstrong, Joanna Perkins, Maura O'Leary, Debra Friedman, Thomas Pendergrass, Brian Greffe, Lorrie Odom, Kathy Ruccione, John MulvihillJill Ginsberg, Anna Meadows, Jean Tersak, A. Kim Ritchey, Julie Blatt, Gregory Reaman, Roger Packer, Stella Davies, Smita Bhatia, Stephen Qualman, Sue Hammond, Amanda Termuhlen, Frederick Ruymann, Lisa Diller, Holcombe Grier, Frederick Li, Lillian Meacham, Ann Mertens, Wendy Leisenring, John Potter, Mark Greenberg, Paul C. Nathan, John Boice, Vilmarie Rodriguez, W. Anthony Smithson, Gerald Gilchrist, Kevin Oeffinger, Jerry Finklestein, Barry Anderson, Peter Inskip, Terry A. Vik, Robert Weetman, Daniel M. Green, Robert Hayashi, Teresa Vietti, Neyssa Marina, Sarah S. Donaldson, Michael P. Link, Zoann Dreyer, Kimberly Whelan, Jane Sande, Roger Berkow, Jackie Casallis, Lonnie Zeltzer, Robert Goldsby, Arthur Ablin, Raymond Hutchinson, Joseph Neglia, Dennis Deapen, Norman Breslow, Dan Bowers, Gail Tomlinson, George R. Buchanan, Louise Strong, Marilyn Stovall

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110 Scopus citations


BACKGROUND. Limited data exist on the comprehensive assessment of late medical and social effects experienced by survivors of childhood and young adult acute myeloid leukemia (AML). METHODS. This analysis included 272 5-year AML survivors who participated in the Childhood Cancer Survivor Study (CCSS). All patients were diagnosed at age ≤21 years between the years 1970 and 1986, and none underwent stem cell transplantation. Rates of survival, relapse, and late outcomes were analyzed. RESULTS. The average follow-up was 20.5 years (range, 5-33 years). The overall survival rate was 97% at 10 years (95% confidence interval [95%CI], 94%-98%) and 94% at 20 years (95% CI, 90%-96%). Six survivors reported 8 recurrences. The cumulative incidence of recurrent AML was 6.6% at 10 years (95% CI, 3.7%-9.6%) and 8.6% at 20 years (95% CI, 5.1%-12.1%). Ten subsequent malignant neoplasms (SMN) were reported, including 4 with a history of radiation therapy, for a 20-year cumulative incidence of 1.7% (95% CI, 0.02%-3.4%). Six cardiac events were reported, for a 20-year cumulative incidence 4.7% (95% CI, 2.1%-7.3%). Half of the survivors reported a chronic medical condition and, compared with siblings, were at increased risk for severe or life-threatening chronic medical conditions (16% vs 5.8%; P < .001). Among those aged ≥25 years, the age-adjusted marriage rates were similar among survivors and the general United States population (57% for both) and lower compared with siblings (67%; P < .01). Survivors' college graduation rates were lower compared with siblings but higher than the general population (40% vs 52% vs 34%, respectively; P < .01). Employment rates were similar between survivors, siblings, and the general population (93%, 97.6%, and 95.8%, respectively). CONCLUSIONS. Long-term survival from childhood AML ≥5-years after diagnosis was favorable. Late-occurring medical events remained a concern with socioeconomic achievement lower than expected within the individual family unit, although it was not different from the general United States population.

Original languageEnglish
Pages (from-to)2071-2079
Number of pages9
Issue number9
StatePublished - May 1 2008


  • Acute myeloid leukemia
  • Medical late effects
  • Social late effects
  • Survivorship


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