Quality of Health in Survivors of Childhood Acute Myeloid Leukemia Treated With Chemotherapy Only: A NOPHO-AML Study

Acute myeloid leukemia (AML) represents 20% of the acuteleukemiacasesinchildrenandadolescents.IntheNordiccountries,AML is diagnosed in approximately 30 children annually in a totalchildpopulationof4.5millionbelowtheageof15years.Thepasttwodecadeshaveseenamarkedimprovementinsurvival.TheresultsoftheNOPHO-AMLstudies(NordicSocietyofPediatricHematologyandOncology)areamongthebestintheworldwitha5-yearsurvivalrate of 65% [1,2]. The late morbidity and mortality after the veryintensive treatment therefore deserve attention.Long-termsurvivorsofchildhoodcancerareatriskofdevelopingseveraladverseoutcomesincludingearlydeath,secondneoplasms,organ dysfunction (e.g., cardiac and pulmonary), growth disturb-ance, reduced fertility, impaired intellectual function, difficultiesinobtainingemploymentandinsurance,andreducedqualityoflife[3–5]. Previous studies have reported common late effects afterchildhood AML [6–15]. In the Childhood Cancer Survivor Study(CCSS),62%ofAMLsurvivorsreportedachronicmedicalcondition[6]. However, most previous studies included rather few AMLsurvivors whose therapy varied considerably. Cranial irradiationhad been givento 9–100% of patients, and hematopoietic stem celltransplantation (HSCT) had been used in 0–60%. Many of the lateeffects reported in previous studies were probably caused by thesetreatments [7,9,10]. From 1984 to 2003, approximately 50% ofNordic children with AML were cured with chemotherapy only.Cranialirradiationwasnotused,andcumulativedosesofanthracy-clines were lower than in most other protocols [1,2]. However, thechemotherapyusedtocureAMLremainedveryintensiveanditsusewasassociatedwithmajoracutetoxicity,includingahighfrequencyof both early (6%) and late toxic death (7%) [2]. Limited data existabout the long-term mortality, morbidity, and social outcomes ofAML patients treated with chemotherapy only.The objective of the Nordic AML Late Effect Study was toinvestigatethespectrum,frequencyandpossibleriskfactorsforlateeffects of childhood AML cured by chemotherapy only. This studycomparedtheself-reporteduseofhealthcareservices,healthexperi-ence,socialoutcomes,andlifestylebehaviorofAMLsurvivorswiththose of their sibling controls.