Late Effects of Therapy Plague Many Patients Who Survived AML as Youths, Young Adults

Patients who develop acute myeloid leukemia (AML) as teenagers and young adults face a significant risk of long-term complications, according to a new study.

The findings, published in the International Journal of Epidemiology, suggest that long-term surveillance of AML survivors is critical in order to avoid late-arriving complications of treatment.

Most people who are diagnosed with AML are middle-aged or older. The American Cancer Society estimates the average age of a patient at AML diagnosis is 68. However, a small portion of patients will develop the disease in childhood or young adulthood.

Lead author Renata Abrahão, MD, MSc, PhD, of the UC Davis Comprehensive Cancer Center, and colleagues, noted that treatments for patients with AML are typically similar regardless of the patient’s age. Generally, patients are given anthracycline- and cytarabine-based induction therapy, and then intensive chemotherapy or hematopoietic stem cell transplantation (HSCT). The differences, however, are that central nervous system-directed therapy is often used in pediatric patients, but not in adult patients, and that adolescents and young adults (AYAs) with AML receive HSCT at a higher rate than older patients.

Abrahão said those aggressive treatment decisions for younger AML patients can be a mixed blessing.

“Although these therapies may result in AML cure, they also contribute to late physical and psychosocial adverse effects in survivors,” Abrahão and colleagues wrote.

In hopes of gaining a better understanding of those effects, the investigators identified 1,168 AYAs with AML who were placed in the California Cancer Registry between 1996 and 2012 and who had survived at least 2 years following diagnosis. Those patients were followed through the year 2014, with hospital discharge data utilized in order to quantify possible late effects of their AML treatment.

The data showed that 10 years following diagnosis, more than a quarter of patients (26%) had developed an endocrine disease; 19% had developed cardiovascular disease; and 7% had developed a respiratory disease. Other serious illnesses were also identified, though at lower rates. Patients who underwent HSCT were twice as likely to experience most of the late effects, the investigators said.

Notably, however, the authors found that non-medical factors appeared to play a role in some of the outcomes. For instance, AYA survivors of AML were more likely to experience late effects if they had lived in a poor neighborhood at the time of their diagnosis. Hispanic, black and Asian/Pacific Islander survivors also faced increased risks.

“The higher risk may relate to the financial hardship that patients with cancer often experience,” said UC Davis’ Theresa Keegan, MS, PhD, the study’s senior author, in a press release. “As a result of cancer, AYA survivors and their families may miss work, experience income loss and incur substantial out-of-pocket expenses.”

Keegan added that factors such as therapeutic management, patient response to treatment, and high-risk mutations in AML can also lead to a higher risk of after effects.

From a physician perspective, Abrahão said the study data underscore the importance of vigilance even years after a diagnosis and cure.

“Our findings can help clinicians and policymakers develop better survivorship care plans to reduce suffering and death among AYA survivors of AML,” she said, in the press release.

Reference:

Abrahão R, Huynh JC, Benjamin DJ, et al. Chronic medical conditions and late effects after acute myeloid leukaemia in adolescents and young adults: a population-based study, International Journal of Epidemiology doi: 10.1093/ije/dyaa184