LAUSR

BACKGROUND Survivors of childhood acute myeloid leukemia (AML) are vulnerable to medical late-effects of treatment; however, less is known about their psychosocial outcomes. This study evaluated neurocognitive and psychosocial outcomes in long-term AML survivors treated with bone marrow transplantation (BMT) or intensive chemotherapy without BMT (IC). METHODS AML survivors (N = 482; median age at diagnosis=8 [range=0-20] years; median age at evaluation=30 [range=18-49] years) treated with BMT (N = 183) or IC (N = 299) and sibling controls (N = 3190; median age at evaluation=32 [range=18-58] years) from the Childhood Cancer Survivor Study were compared on emotional distress (Brief Symptom Inventory-18), neurocognitive problems (CCSS Neurocognitive Questionnaire), Health-related Quality of Life (SF-36) and social attainment. Outcomes were dichotomized (impaired vs. non-impaired) using established criteria, and relative risks (RRs) were estimated with multivariable Poisson regression, adjusted for age-at-evaluation and sex. RESULTS AML survivors were more likely than siblings to report impairment in overall emotional (RR = 2.19, 95% CI = 1.51 to 3.18), neurocognitive (RR = 2.03, 95% CI = 1.47 to 2.79), and physical quality of life (RR = 2.71, 95% CI = 1.61 to 4.56) outcomes. Survivors were at increased risk for lower education (RR = 1.15, 95% CI = 1.03 to 1.30), unemployment (RR = 1.41, 95% CI = 1.16 to 1.71), lower income (RR = 1.39, 95% CI = 1.17 to 1.65) and not being married/partnered (RR = 1.33, 95% CI = 1.17 to 1.51). BMT-treated survivors did not differ statistically significantly from IC-treated on any outcome measure. CONCLUSIONS AML survivors are at increased risk for psychosocial impairment compared to siblings; however, BMT does not confer additional risk for psychosocial late-effects compared to treatment without BMT.