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Blood, 15 June 2008, Vol. 111, No. 12, pp. 5515-5523. Prepublished online as a Blood First Edition Paper on March 11, 2008; DOI 10.1182/blood-2007-10-117150. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2007-10-117150v1 111/12/5515    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Mody, R. Articles by Neglia, J. P. PubMed PubMed Citation Articles by Mody, R. Articles by Neglia, J. P. Related Collections Neoplasia Free Research Articles Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Twenty-five–year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study Rajen Mody1, Suwen Li2, Douglas C. Dover2, Stephen Sallan3, Wendy Leisenring4, Kevin C. Oeffinger5, Yutaka Yasui2, Leslie L. Robison6, and Joseph P. Neglia7 1 Department of Pediatrics, University of Michigan, Ann Arbor; 2 School of Public Health, University of Alberta, Edmonton, AB; 3 Department of Biostatistics, The Fred Hutchinson Cancer Research Center, Seattle, WA; 4 Department of Pediatrics, Dana-Farber Cancer Institute, Boston, MA; 5 Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; 6 Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN; and 7 Department of Pediatrics, University of Minnesota, Minneapolis Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for late effects of cancer therapy. Five-year ALL survivors (< 21 years at diagnosis; n = 5760 eligible, 4151 participants), diagnosed from 1970 to 1986 were compared with the general population and a sibling cohort (n = 3899). Cumulative mortality of 5760 5-year survivors was 13% at 25 years from diagnosis. Recurrent ALL (n = 483) and second neoplasms (SNs; n = 89) were the major causes of death. Among 185 survivors, 199 SNs occurred, 53% in the CNS. Survivors reported more multiple chronic medical conditions (CMCs; odds ratio [OR], 2.8; 95% CI, 2.4-3.2) and severe or life-threatening CMCs (OR, 3.6; 95% CI, 3.0-4.5) than siblings. Cumulative incidence of severe CMCs, including death, 25 years from diagnosis was 21.3% (95% CI, 18.2-24.4; 23.3% [95% CI, 19.4-27.2] and 13.4% [95% CI, 8.4-18.4] for irradiated and nonirradiated survivors, respectively). Survivors reported more adverse general and mental health, functional impairment, and activity limitations compared with siblings (P < .001). Rates of marriage, college graduation, employment, and health insurance were all lower compared with sibling controls (P < .001). Long-term survivors of childhood ALL exhibit excess mortality and morbidity. Survivors who received radiation therapy as part of their treatment or had a leukemia relapse are at greatest risk for adverse outcomes. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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