Health Conditions and Quality of Life in Survivors of Childhood Acute Myeloid Leukemia Comparing Post Remission Chemotherapy to BMT: A Report from the Children's Oncology Group

• Authors: Kris Ann P. Schultz, Children's Hospitals and Clinics of Minnesota; Lu Chen, Children's Oncology Group; Zhengjia Chen, Emory University; Toana Kawashima, Fred Hutchinson Cancer Research Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Research Center; William G Woods, Emory University; H. Stacy Nicholson, Oregon Health and Science University; Joseph P. Neglia, University of Minnesota
• Journal Title: Pediatric Blood and Cancer
• Volume: Volume 61, Number 4
• Publisher: Wiley: 12 months | 2014-04-01, Pages 729-736
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/pbc.24881
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Hematology; Pediatrics; acute myeloid leukemia; bone marrow transplantation; chronic health condition; late effects; pediatric; quality of life; BONE-MARROW-TRANSPLANTATION; CANCER-GROUP; ADULT SURVIVORS; THERAPY; INDUCTION; OUTCOMES; TRIALS; COHORT

Abstract

Background: Therapy for childhood acute myeloid leukemia (AML) has historically included chemotherapy with or without autologous bone marrow transplant (autoBMT) or allogeneic hematopoietic stem cell transplantation (alloBMT). We sought to compare health-related quality-of-life (HRQOL) outcomes between these treatment groups. Procedure: Five-year survivors of AML diagnosed before age 21 and enrolled and treated from 1979 to 1995 on one of 4 national protocols were interviewed. These survivors or proxy caregivers completed a health questionnaire and an HRQOL measure. Results: Of 180 survivors, 100 were treated with chemotherapy only, 26 with chemotherapy followed by autoBMT, and 54 with chemotherapy followed by alloBMT. Median age at interview was 20 years (range 8-39). Twenty-one percent reported a severe or life-threatening chronic health condition (chemotherapy-only 16% vs. autoBMT 21% vs. alloBMT 33%; P=0.02 for chemotherapy-only vs. alloBMT). Nearly all (95%) reported excellent, very good or good health. Reports of cancer-related pain and anxiety did not vary between groups. HRQOL scores among 136 participants ≥14 years of age were similar among groups and to the normative population, though alloBMT survivors had a lower physical mean summary score (49.1 alloBMT vs. 52.2 chemotherapy-only; P=0.03). Multivariate analyses showed the presence of severe chronic health conditions to be a strong predictor of physical but not mental mean summary scores. Conclusions: Overall HRQOL scores were similar among treatment groups, although survivors reporting more health conditions or cancer-related pain had diminished HRQOL. Attention to chronic health conditions and management of cancer-related pain may improve QOL.