LAUSR

Five-year survival following childhood acute myeloid leukemia (AML) has increased due to improvements in treatment and supportive care. The impact of these changes on long-term health outcomes is unknown. To address this, cumulative incidence of late mortality and grades 3-5 chronic health conditions (CHCs) standardized mortality ratios (SMR) were estimated among five-year AML survivors from the Childhood Cancer Survivor Study diagnosed 1970-1999. Survivors were compared by treatment group (hematopoietic cell transplantation [HCT]; chemotherapy with cranial radiation [chemo+CRT]; chemotherapy only [chemo-only]) and decade of diagnosis. Self-reported health status was compared across treatments, decade of diagnosis, and with siblings. Among 856 survivors (median diagnosis age 7.1 years; median age at last follow-up 29.4 years) the 20-year late mortality cumulative incidence was highest after HCT (13.9%, 95%CI 10.0-17.8%; chemo+CRT 7.6%, 95%CI 2.2-13.1%; chemo-only 5.1%, 95%CI 2.8-7.4%). Mortality cumulative incidence decreased for survivors of HCT diagnosed in the 1990s (8.5%, 95%CI 4.1-12.8%) compared with the 1970s (38.9%, 95%CI 16.4-61.4%), as did SMRs. Most survivors did not experience any grade 3-5 CHC after 20 years (HCT, 45.8%; chemo+CRT 23.7%; chemo-only 27.0%). Furthermore, a temporal reduction in CHC cumulative incidence was seen after HCT (1970s, 76.1%; 1990s, 38.3%; p=0.02), mirroring a reduction in total body irradiation use. Self-reported health status was good to excellent for 88.2% of survivors, regardless of treatment; however, this was lower than siblings (94.8%; p<0.0001). Although HCT is associated with greater long-term morbidity and mortality compared with chemotherapy-based treatment, these gaps have narrowed and all treatment groups report favorable health status.