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ACUTE MYELOID LEUKEMIA

Late outcomes in survivors of childhood acute myeloid leukemia: a report from the St. Jude Lifetime Cohort Study

Leukemia volume 35, pages 2258–2273 (2021)Cite this article

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Abstract

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.

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Fig. 1: Cumulative burden and 95% confidence intervals of chronic health conditions among survivors of AML treated with allogeneic hematopoietic cell transplant (HCT) or conventional therapy (non-HCT) and community controls.
Fig. 2: Neurocognitive impairment among HCT survivors and controls by domains.
Fig. 3: Neurocognitive impairment among CT survivors and controls by domains.
Fig. 4: Prevalence of physical function impairments among survivors of AML.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Statistical code is available upon request. Study protocol is available at Clinical Trials.gov (NCT00760656).

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Funding

This study was supported by the National Cancer Institute: Cancer Center Support (CORE) Grant (CA21765) to St. Jude Children’s Research Hospital (PI: Dr. Charles W. Roberts) and U01 CA195547 (MPI: MMH and LLR) and the American Lebanese Syrian Associate Charities (ALSAC), Memphis, TN.

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Author notes

  1. These authors contributed equally: Neel S. Bhatt, Malek J. Baassiri

Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Neel S. Bhatt

  2. Department of Pediatrics, University of Washington, Seattle, WA, USA

    Neel S. Bhatt

  3. Department of Pediatrics, Dr. Sulaiman Al Habib Hospital, Al Khobar, Kingdom of Saudi Arabia

    Malek J. Baassiri

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Wei Liu & Deokumar Srivastava

  5. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Nickhill Bhakta, Wassim Chemaitilly, Matthew J. Ehrhardt, Kevin Krull, Kirsten K. Ness, Leslie L. Robison, Melissa M. Hudson & Daniel A. Mulrooney

  6. Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Nickhill Bhakta

  7. Department of Pediatric Medicine, Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Wassim Chemaitilly

  8. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Matthew J. Ehrhardt, Hiroto Inaba, Jeffrey E. Rubnitz, Melissa M. Hudson & Daniel A. Mulrooney

  9. Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Kevin Krull

  10. Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA

    Melissa M. Hudson & Daniel A. Mulrooney

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  1. Neel S. Bhatt
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  3. Wei Liu
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Bhatt, N.S., Baassiri, M.J., Liu, W. et al. Late outcomes in survivors of childhood acute myeloid leukemia: a report from the St. Jude Lifetime Cohort Study. Leukemia 35, 2258–2273 (2021). https://doi.org/10.1038/s41375-021-01134-3

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