Late morbidity and mortality in adult survivors of childhood glioma with neurofibromatosis type 1: report from the Childhood Cancer Survivor Study

Abstract

Purpose

Neurofibromatosis type 1 (NF1) is associated with tumor predisposition and nonmalignant health conditions. Whether survivors of childhood cancer with NF1 are at increased risk for poor long-term health outcomes is unknown.

Methods

One hundred forty-seven 5+ year survivors of childhood glioma with NF1 from the Childhood Cancer Survivor Study were compared with 2629 non-NF1 glioma survivors and 5051 siblings for late mortality, chronic health conditions, and psychosocial, neurocognitive, and socioeconomic outcomes.

Results

Survivors with NF1 (age at diagnosis: 6.8 ± 4.8 years) had greater cumulative incidence of late mortality 30 years after diagnosis (46.3% [95% confidence interval: 23.9–62.2%]) compared with non-NF1 survivors (18.0% [16.1–20.0%]) and siblings (0.9% [0.6–1.2%]), largely due to subsequent neoplasms. Compared with survivors without NF1, those with NF1 had more severe/life-threatening chronic conditions at cohort entry (46.3% [38.1–54.4%] vs. 30.8% [29.1–32.6%]), but similar rates of new conditions during follow-up (rate ratio: 1.26 [0.90–1.77]). Survivors with NF1 were more likely to report psychosocial impairments, neurocognitive deficits, and socioeconomic difficulties compared with survivors without NF1.

Conclusions

Late mortality among glioma survivors with NF1 is twice that of other survivors, due largely to subsequent malignancies. Screening, prevention, and early intervention for chronic health conditions and psychosocial and neurocognitive deficits may reduce long-term morbidity in this vulnerable population.

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Fig. 1: Cumulative incidence of all-cause mortality starting five years from tumor diagnosis.
Fig. 2

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Acknowledgements

This work was supported by grants from the National Institutes of Health (CA55727, and a Cancer Center Support (CORE) grant CA21765); the American Lebanese–Syrian Associated Charities (ALSAC); and the Neurofibromatosis Therapeutic Acceleration Program (Francis Collins Scholar to P.d.B.). This publication was supported by an agreement from the Johns Hopkins University School of Medicine and the Neurofibromatosis Therapeutic Acceleration Program. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of The Johns Hopkins School of Medicine.

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Correspondence to Peter de Blank MD, MSCE.

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de Blank, P., Li, N., Fisher, M.J. et al. Late morbidity and mortality in adult survivors of childhood glioma with neurofibromatosis type 1: report from the Childhood Cancer Survivor Study. Genet Med (2020). https://doi.org/10.1038/s41436-020-0873-7

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Keywords

  • glioma
  • neurofibromatosis type 1
  • cancer survivorship
  • pediatric brain tumor