AYA Leukemia Survivors: 'Cure Is Not Enough'

Roxanne Nelson, RN, BSN

May 20, 2022

Although adolescents and young adults (AYAs) who survive leukemia are living much longer than ever before, their life spans are still shorter than those of the general population, a new study concludes.

The study found that the 10-year survival of AYA leukemia survivors was approximately 10% lower than that of the age-adjusted US general population at large. These differences persisted for up to 30 years of follow-up.

"We need to think about the long-term life span and the quality of life for our patients. Cure is not enough for our AYA cancer survivors," said senior author Michael Roth, MD, associate professor of pediatrics patient care and director of the Childhood Cancer Survivorship Clinic at the University of Texas MD Anderson Cancer Center, Houston.

"Once these patients reach the survivorship stage of their journey, they may encounter additional side effects as a result of intensive treatment, lack of access to quality healthcare, and other issues that may negatively impact their health and overall survival," he said in a statement.

The study was published in Cancer Epidemiology, Biomarkers and Prevention.

Demographics Play Role in Survival

AYAs were defined as those persons aged 15–39 years. For their study, Roth and colleagues used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 1938 AYA survivors of acute lymphoblastic leukemia (ALL) and 2350 AYA survivors of acute myeloid leukemia (AML) who were diagnosed from 1980–2009. They were followed for a median of 12 years.

The median age at diagnosis was 23 years for ALL and 28 years for AML.

Among ALL survivors, 6% were Black, 7% were Asian or Pacific Islander, 29% were Hispanic, and 58% were White. Among AML survivors, 9% were Black, 10% were Asian or Pacific Islander, 22% were Hispanic, and 59% were White.

Ten-year survival for ALL and AML survivors was 87% and 89%, respectively. For the general population, it was 99%.

For ALL survivors, the 10-year survival was 83% for those diagnosed in the 1980s; it was 88% for those diagnosed in the 1990s and in the 2000s.

The pattern was similar for AML survivors: 82%, 90%, and 90%.

The most common cause of death during early survivorship was acute leukemia. Deaths plateaued approximately 10 years after the initial diagnosis.

"Some of these patients aren't being fully cured of their initial cancer, so between 5 and 10 years post initial diagnosis, most of the deaths are due to disease progression or relapse, whereas after that, most of the deaths result from late side effects from treatment, including cardiovascular disease and secondary cancers," Roth said.

Mortality from other causes continued to rise during the survivorship period. Subsequent malignancies and cardiac disease were the most common causes of death for both ALL and AML survivors.

A recent study found that AYA cancer survivors face nearly a twofold higher risk of dying from a new primary cancer compared with peers in the general population.

When looking at key demographics, the authors found that older age at diagnosis was significantly associated with differential long-term survival (P < .0001 for both ALL and AML). Each additional year older at diagnosis was associated with a 6% and 5% decrease in long-term survival for both types of leukemia.

The decade in which the diagnosis was made had a significant difference in long-term survival both for patients with ALL and those with AML. Long-term survival times for those diagnosed in the 1990s were more than twice those of patients diagnosed in the 1980s for ALL (unadjusted P = .008) and AML (unadjusted P = .0002). Survival times were also more than twice those of patients diagnosed in the 2000s vs the 1980s for ALL (unadjusted P = .009) and AML (unadjusted P = .0003).

No significant long-term survival differences were observed for those diagnosed in the 2000s compared with the 1990s for either leukemia.

"The data from the national registry used for this study gave us insights into some possible challenges AML and ALL patients may encounter throughout survivorship, but we need to more thoroughly survey their journey," Roth said. "An examination of their socioeconomic status, comorbidities, access to quality healthcare, and other risk factors that may impact their survivorship is warranted."

The research was supported by the National Cancer Institute at the National Institutes of Health, the Archer Charitable Foundation, and LyondellBasell. The authors have disclosed no relevant financial relationships.

Cancer Epidemiol Biomarkers Prev. Published online May 13, 2022. Abstract

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