Late Effects in Survivors of Adolescent and Young Adult Acute Lymphoblastic Leukemia
Menée à partir des données du registre californien des cancers portant sur 1 062 adolescents et jeunes adultes (âge : 15-39 ans) ayant survécu 3 ans ou plus à une leucémie lymphoblastique aiguë diagnostiquée entre 1995 et 2012, cette étude analyse les facteurs associés à la survenue tardive d’effets indésirables (maladies et dysfonctionnements physiques, second cancer)
Background : Knowledge regarding late effects (medical conditions and subsequent neoplasms) in survivors of adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) is lacking. Methods : Using the population-based California Cancer Registry (CCR) linked with California hospitalization data, we evaluated late effects in 1,069 AYAs (age 15-39 years) diagnosed with ALL in California between 1995-2012 and surviving a minimum of three years from diagnosis. Results : The estimated 10-year cumulative incidence of subsequent endocrine disease [28.7% (95% CI, 25.8- 31.6)] and cardiac disease [17.0% (95% CI, 14.6-19.5)] were strikingly high; avascular necrosis [9.6% (95% CI, 7.8-11.6], respiratory disease [6.2% (95% CI, 4.8-8.0)], liver disease [6.5 % (95% CI, 5.0-8.3)], seizure/stroke [4.3% (95% CI, 3.1- 5.8)], renal disease [3.1% (95% CI, 2.1, 4.4)] and second neoplasms [1.4 (95% CI, 0.7-2.4)] were estimated to occur at 10 years with the reported frequencies. Multivariable analyses including the entire patient cohort demonstrated that public or no insurance (vs private/military insurance) and receipt of hematopoietic cell transplantation (HCT) were independently associated with the occurrence of all late effects considered. In multivariable analyses limited to the 766 AYAs who were not transplanted, we continued to find a statistically significant association between public and no insurance and the occurrence of all late effects. Front-line regimen type (pediatric vs adult) was not statistically significantly associated with any of the late effect categories. Conclusions : This large population-based analysis is amongst the first to describe late effects in survivors of AYA ALL. The strong association between insurance type and late effects suggests that AYAs with public or no insurance may have reduced access to survivorship care following completion of ALL therapy.
JNCI Cancer Spectrum 2020