Late outcomes in survivors of childhood acute myeloid leukemia: a report from the St. Jude Lifetime Cohort Study.
Neel S BhattMalek J BaassiriWei LiuNickhill H BhaktaWassim ChemaitillyMatthew J EhrhardtHiroto InabaKevin KrullKirsten K NessJeffrey E RubnitzDeokumar SrivastavaLeslie L RobisonMelissa M HudsonDaniel A MulrooneyPublished in: Leukemia (2021)
Cumulative burden of chronic health conditions and neurocognitive and physical function were examined among survivors of childhood acute myeloid leukemia (AML) treated with hematopoietic cell transplant (HCT; n = 66) or conventional therapy (CT; n = 67). Survivors and controls underwent a comprehensive clinical assessment, and health conditions were graded using a modified version of the Common Terminology Criteria for Adverse Events. By age 40 years, HCT and CT survivors had an average 17.4 (95% confidence interval [CI] 14.6-20.1) and 9.3 (7.7-11.1) grade 1-4 conditions versus 3.8 (3.3-4.2) in community controls. Compared to controls, HCT survivors had a higher prevalence of hypertriglyceridemia (45.5% vs. 18.3%), hypercholesterolemia (47.0% vs. 30.9%), hypothyroidism (27.3% vs. 4.0%), and primary hypogonadism (p < 0.001). CT survivors had a higher prevalence of cardiomyopathy (11.9% vs. 2.7%) and hypertension (53.7% vs. 44.3%). Neurocognitive impairment was elevated across all domains compared to controls but did not differ by treatment modality. Compared to controls, a higher proportion of HCT survivors had impairments in strength and endurance; whereas flexibility and mobility impairments were noted among CT survivors. Despite successful advances in childhood AML therapy, many therapeutic exposures remain unchanged. These findings support ongoing investigations of novel therapies and strategies to ameliorate the risk of late morbidities.
Keyphrases
- acute myeloid leukemia
- young adults
- computed tomography
- image quality
- healthcare
- contrast enhanced
- public health
- mental health
- allogeneic hematopoietic stem cell transplantation
- dual energy
- heart failure
- blood pressure
- bipolar disorder
- stem cells
- cell proliferation
- metabolic syndrome
- single cell
- air pollution
- social media
- cell death
- adipose tissue
- climate change
- atrial fibrillation
- acute lymphoblastic leukemia
- body composition
- insulin resistance
- signaling pathway
- high intensity
- human health
- smoking cessation
- clinical evaluation