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Survivors of Childhood Leukemia Faring Well

More than 90 percent who are alive five years after treatment are still alive 20 years later

MONDAY, Dec. 11, 2006 (HealthDay News) -- More than 90 percent of children who survive acute myeloid leukemia (AML) five years after treatment are still alive 20 years later and leading full, productive lives, a new study finds.

However, the long-term affects of treatment, such as new cancers and heart problems, need to be monitored with yearly check-ups, the University of Minnesota researchers say.

"Among five-year AML survivors, long-term survival seems to be quite favorable and came out at more than 90 percent," said lead researcher Dr. Daniel Mulrooney, a pediatric oncologist and researcher at the university.

The findings are the first comprehensive study to analyze 20 years of follow-up on survivors who were diagnosed and treated for AML as children and young adults. The study was expected to be presented Monday at the annual meeting of the American Society of Hematology, in Orlando, Fla.

Leukemias are the most common cancer affecting children and young adults. AML, a cancer of the blood and bone marrow, accounts for about 25 percent of all childhood leukemias. AML is a particularly virulent cancer with only about a 50 percent survival rate at five years, Mulrooney said.

Among survivors, there is an increased risk of relapse with AML or other cancers. Moreover, AML survivors are at risk of other medical problem, such as heart disease and cognitive impairment, resulting from the aggressiveness of the initial treatment, the researchers said.

For the study, Mulrooney's group collected data on 272 AML survivors, part of the Childhood Cancer Survivor Study, who were younger than 21 when diagnosed and treated between 1970-1986. Fifty-six percent of the survivors had received only chemotherapy, and 34 percent were treated with both chemotherapy and radiation. The researchers looked at late health effects, marriage, education, and employment rates of the survivors, compared with a group of their siblings.

"We did continue to see a number of late recurrences, and we saw medical late effects of therapy, such as second cancers and effects upon the heart presenting years later after therapy," Mulrooney said.

The investigators found that 10 years after therapy, 97 percent of the patients were living, and after 20 years, 94 percent were still alive. Six survivors had a recurrence of AML. Two died from the disease, one died from congestive heart failure, and another died from a heart attack. The rate of AML recurrence was 1.8 percent at 10 years and 3.7 percent at 20 years, the researchers found.

"In addition, we found that the rates of marriage, education and employment were lower than the siblings of the survivors, but when you compared with the general population the cancer survivors were actually doing better," Mulrooney said.

The researchers found that marriage rates among survivors were similar to the general U.S. population at 57 percent, but lower compared to their siblings, at 67 percent.

In addition, 40 percent of the cancer survivors graduated from college, compared with 52 percent of their siblings and 34 percent of the general population. Also, 93 percent of the survivors and 98 percent of their siblings were employed, and 92 percent of the survivors reported having health insurance, compared with 89 percent of the siblings.

"Overall survival in this population of five-year cancer survivors is quite good. However, medical late effects continue to be a problem," Mulrooney said. "Long-term monitoring of AML survivors is still important."

One expert thinks the findings show there has been encouraging progress in the treatment of AML.

"This is important information because more people with cancer are having their lives extended," said Dr. Marshall Lichtman, executive vice president of research and medical programs at the Leukemia & Lymphoma Society. "The five-year survival of children with AML is approaching 50 percent," he noted.

In the future, Lichtman hopes that treatment with newer drugs will reduce the number of later medical problems.

"The long-term survival and the likelihood that survivors will lead a normal life is very positive," Lichtman said. "Unfortunately, a small proportion of survivors suffer long-term effects. But put in the context of the virulent nature of this cancer, and the requirements for very intense prolonged chemotherapy, the outcome here is very good."

More information

The American Cancer Society can tell you more about AML.

SOURCES: Daniel Mulrooney, M.D., pediatric oncologist and researcher, University of Minnesota Medical School and Cancer Center, Minneapolis; Marshall Lichtman, M.D., executive vice president, research and medical programs, Leukemia & Lymphoma Society, White Plains, N.Y.; Dec. 11, 2006, presentation, American Society of Hematology annual meeting, Orlando, Fla.
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