Long-Term Outcomes among Adolescent and Young Adult Survivors of Acute Leukemia: A Surveillance, Epidemiology, and End Results Analysis

Abstract

Background: There is a growing population of adolescent and young adult (AYA, age 15-39 years) acute leukemia survivors in whom long-term mortality outcomes are largely unknown.

Methods: The current study utilized the Surveillance, Epidemiology, and End Results (SEER) registry to assess long-term outcomes of AYA acute leukemia 5-year survivors. The impact of diagnosis age, sex, race/ethnicity, socioeconomic status, and decade of diagnosis on long-term survival were assessed utilizing an accelerated failure time model.

Results: A total of 1,938 AYA acute lymphoblastic leukemia (ALL) and 2,350 AYA acute myeloid leukemia (AML) survivors diagnosed between 1980 and 2009 were included with a median follow-up of 12.3 and 12.7 years, respectively. Ten-year survival for ALL and AML survivors was 87% and 89%, respectively, and 99% for the general population. Survival for AYA leukemia survivors remained below that of the age-adjusted general population at up to 30 years of follow-up. Primary cancer mortality was the most common cause of death in early survivorship with noncancer causes of death becoming more prevalent in later decades of follow-up. Male AML survivors had significantly worse survival than females (survival time ratio: 0.61, 95% confidence interval: 0.45-0.82).

Conclusions: AYA leukemia survivors have higher mortality rates than the general population that persist for decades after diagnosis.

Impact: While there have been improvements in late mortality, long-term survival for AYA leukemia survivors remains below that of the general population. Studies investigating risk factors for mortality and disparities in late effects among long-term AYA leukemia survivors are needed.

Figure 1.

Kaplan Meier curves showing: A) survival over time among 5-year survivors of AYA ALL and AML compared with the age-adjusted expected survival of the general population; B) death by acute leukemia and death by other causes over time in 5-year survivors of AYA ALL; C) death by acute leukemia and death by other causes over time in 5-year survivors of AYA AML.

Figure 2.

Kaplan Meier curves showing survival over time by: A) age at diagnosis in 5-year survivors of AYA ALL; B) age at diagnosis in 5-year survivors of AYA AML; C) sex in 5-year survivors of AYA ALL; D) sex in 5-year survivors of AYA AML; E) race ethnicity in 5-year survivors of AYA ALL; F) race/ethnicity in 5-year survivors of AYA AML; G) SES by tertile in 5-year survivors of AYA ALL; H) SES by tertile in 5-year survivors of AYA AML; I) decade of diagnosis in 5-year survivors of AYA ALL; J) decade of diagnosis in 5-year survivors of AYA AML.