Title

Impact of Risk-Stratified Therapy on Health Status in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Authors

Stephanie B. Dixon, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. stephanie.dixon@stjude.org.
Yan Chen, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Yutaka Yasui, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Ching-Hon Pui, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Stephen P. Hunger, Division of Oncology and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Lewis B. Silverman, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Kirsten K. Ness, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Daniel M. Green, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Rebecca M. Howell, Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, Texas.
Wendy M. Leisenring, Cancer Prevention and Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Nina S. Kadan-Lottick, Section of Pediatric Hematology/Oncology at Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut.
Kevin R. Krull, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Kevin C. Oeffinger, Department of Medicine, Duke University, Durham, North Carolina.
Joseph P. Neglia, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Melissa M. Hudson, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Leslie L. Robison, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Ann C. Mertens, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Gregory T. Armstrong, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Paul C. Nathan, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Abstract

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 (), standard- and high-risk 1980s and 1990s therapy (, , , ), and relapse/bone marrow transplant (). 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 , and were less likely to report poor general health (: PR = 0.75; 95% CI, 0.57-0.98; : PR = 0.58; 95% CI, 0.39-0.87), functional impairment (: PR = 0.56; 95% CI, 0.42-0.76; : PR = 0.63; 95% CI, 0.42-0.95), and activity limitations (: 0.61; 95% CI, 0.45-0.83; : PR = 0.59; 95% CI, 0.38-0.91). An added adjustment for chronic conditions in multivariable models partially attenuated 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.

Publication Title

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

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