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. 2023 Jan 17;15(3):575.
doi: 10.3390/cancers15030575.

At What Point Are Long-Term (>5 Years) Survivors of APL Safe? A Study from the SEER Database

Xue-Jiao Yin  1   2 , Rong Wang  1   2 , Hong-Shi Shen  3 , Jie Jin  1   2   4 , Hong-Hu Zhu  1   2   4   5   6
Affiliations

At What Point Are Long-Term (>5 Years) Survivors of APL Safe? A Study from the SEER Database

Xue-Jiao Yin et al. Cancers (Basel). .

Abstract

Background: Acute promyelocytic leukemia (APL) is a highly curable cancer, but it is not clear whether it is also necessary to monitor long-term toxicity in "cured" patients who survive for more than five years, which is critical to ensuring maximum survival in APL patients.

Methods: A total of 1952 APL 5-year survivors and 5973 non-APL acute myeloid leukemia (AML) 5-year survivors were included from the Surveillance, Epidemiology, and End Results (SEER) database. The standardized mortality ratio (SMR) was calculated to measure the risk of death. Cumulative mortality is calculated as the incidence of specific causes of death under competing risk events.

Results: The SMR of all causes of death in >5-year survivors of APL was higher than that of the general population only at 60-119 months (SMR, 1.41). This was mainly because a significant increase in mortality from AML (SMR, 87.67) and second malignant neoplasms (SMNs) (SMR, 1.56) was found only at 60-119 months. However, there was no higher risk of death from non-cancer-related disease in >5-year survivors of APL than that of the general population (SMR, 0.89). The SMR of all-cause deaths in >5-year survivors of non-APL AML decreased year by year and was no higher than that of the general population until after 216 months. The cumulative incidence of AML-related death, SMN-related death, and non-cancer-related death was significantly lower in APL patients than in non-APL AML patients throughout the follow-up period.

Conclusions: Compared with the general population, the risk of death of patients with APL was higher within 5 to 10 years but not higher over 10 years. Therefore, we believe that long-term survivors of APL are safe after 10 years.

Keywords: APL; SEER; causes of death; long-term survivors; standardized mortality ratios.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The SMRs of all-cause deaths among >5-year survivors of APL (A) and non-APL AML (B) compared with the general population stratified by demographics and clinical characteristics. The solid vertical lines represent the SMR of 1.0. The horizontal lines represent 95% confidence intervals for the SMRs. The box represents the result of SMR. The diamond at the bottom shows the summary SMR of all the combined individual studies. We used the Poisson exact method for SMR to compute the 95% CI and corresponding p values, and the 95% CIs not including 1 with p < 0.05 were defined as significant differences for SMR. * p < 0.05.
Figure 2
Figure 2
SMRs of site-specific death among >5-year survivors of APL (A) and non-APL AML (B) compared with the general population. The solid vertical lines represent the SMR of 1.0. The horizontal lines represent 95% confidence intervals for the SMRs. The box represents the result of SMR. The diamond at the bottom shows the summary SMR of all the combined individual studies. We used the Poisson exact method for SMR to compute the 95% CI and corresponding p values, and the 95% CIs not including 1 with p < 0.05 were defined as significant differences for SMR. * p < 0.05.
Figure 3
Figure 3
The cumulative incidences of AML-related death, SMN-related death, and non-cancer-related death among >5-year survivors of APL and non-APL AML.
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