Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies and solid tumors, and increasingly, non-malignant diseases. Given improvements in care, there is a growing number of long-term survivors of pediatric HCT. Compared with non-transplanted childhood cancer survivors, HCT survivors have been shown to have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pre-transplant treatment exposures and organ dysfunction, the transplant conditioning regimen, and any post-transplant graft versus host disease (GVHD). In response, the Children’s Oncology Group (COG) has created Long-Term Follow-Up Guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those treated with HCT. Guidelines taskforces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other healthcare professionals, and patient advocates have systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided here-in is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those transplanted for non-malignant diseases, and those with a history of chronic GVHD.

Objectives The purpose of the study was to characterize the psychometric functions that describe task performance in dual-task listening effort measures as a function of signal-to-noise ratio (SNR). Design Younger adults with normal hearing (YNH, n = 24; Experiment 1) and older adults with hearing impairment (OHI, n = 24; Experiment 2) were recruited. Dual-task paradigms wherein the participants performed a primary speech recognition task simultaneously with a secondary task were conducted at a wide range of SNRs. Two different secondary tasks were used: an easy task (i.e., a simple visual reaction-time task) and a hard task (i.e., the incongruent Stroop test). The reaction time (RT) quantified the performance of the secondary task. Results For both participant groups and for both easy and hard secondary tasks, the curves that described the RT as a function of SNR were peak shaped. The RT increased as SNR changed from favorable to intermediate SNRs, and then decreased as SNRs moved from intermediate to unfavorable SNRs. The RT reached its peak (longest time) at the SNRs at which the participants could understand 30% to 50% of the speech. In Experiments 1 and 2 the dual-task trials that had the same SNR were conducted in one block. To determine if the peaked shape of the RT curves was specific to the blocked SNR presentation order used in these experiments, YNH participants were recruited (n = 25; Experiment 3) and dual-task measures, wherein the SNR was varied from trial to trial (i.e., non-blocked), were conducted. The results indicated that, similar to the first two experiments, the RT curves had a peaked shape. Conclusions Secondary task performance was poorer at the intermediate SNRs than at the favorable and unfavorable SNRs. This pattern was observed for both YNH and OHI participants and was not affected by either task type (easy or hard secondary task) or SNR presentation order (blocked or non-blocked). The shorter RT at the unfavorable SNRs (speech intelligibility < 30%) possibly reflects that the participants experienced cognitive overload and/or disengaged themselves from the listening task. The implication of using the dual-task paradigm as a listening effort measure is discussed.

Long-term survivors of childhood and adolescent cancer who were treated with RT are at highest risk for developing NMSC. Educational efforts need to be directed to this population to facilitate early diagnosis of NMSC and reduction in sun exposure.

Despite being associated with a significant incidence of infection, we believe the benefits of IVADs for children with hemophilia and their families outweigh the risks. Possible explanations for the observed infection rates are discussed.

Of the survivors evaluated, typical late effects seen after radiation exposure are common, yet most subjects were doing well without major ongoing medical issues. Dyslipidemias affect more than half of patients and may be associated with metabolic syndrome, placing patients at increased risk for early cardiovascular disease. Even in this group of patients where the majority was exposed to TBI at a very young age, most are functioning at an average or above-average level.

Objective Increased cardiovascular (CV) risk has been reported in adults who are childhood cancer survivors (CCS). We sought to determine the emergence of CV risk factors in CCS while still children. Study design CCS in remission ≥5 years from cancer diagnosis (n=319, age=14.5yrs), and their siblings (controls, n=208, age=13.6yrs) participated in this cross-sectional study of CV risk, which included physiologic assessment of insulin sensitivity/resistance (hyperinsulinemic euglycemic clamp). Adjusted comparisons between CCS major diagnoses (leukemia [n=110], central nervous system tumors [n=82], solid tumors [n=127]) and controls were performed using linear regression for CV risk factors and insulin sensitivity. Results Despite no significant differences in weight and body mass index, CCS had greater adiposity (waist [73.1 vs. 71.1cm, p=0.02]; percent fat [28.1vs.25.9%, p=0.007]), lower lean body mass (38.4vs.39.9 kg, p=0.01) than controls. After adjustment for adiposity, CCS had higher total cholesterol (154.7vs.148.3mg/dl, p=0.004), LDL-cholesterol (89.4vs.83.7mg/dl, p=0.002), triglycerides (91.8 vs. 84mg/dl, p=0.03) and were less insulin sensitive (Mlbm 12.1vs.13.4mg/kg/min, p=0.002) than controls. Conclusions CCS have greater CV risk than healthy children. Because CV risk factors track from childhood into adulthood, early development of altered body composition and decreased insulin sensitivity in CCS may contribute significantly to their risk of early CV morbidity and mortality.

Purpose Little is known about infections among adult survivors of childhood cancer. We report the occurrence of and risk factors for infections in a large cohort of survivors of childhood cancer. Methods Using the Childhood Cancer Survivor Study (CCSS) cohort, incidence rates of infections among 12,360 five-year survivors of childhood cancer, were compared to those of 4,023 siblings. Infection-related mortality of survivors was compared to the U.S. population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratio (RR) and corresponding 95% confidence intervals (CI) for associations with infectious complications. Results Compared with the U.S. population, survivors were at an increased risk of death from infectious causes (Standardized Mortality Ratio (SMR)= 4.2; 95% CI, 3.2-5.4), with females (SMR= 3.2; 95% CI, 1.5-6.9) and those exposed to total body irradiation (SMR= 7.8; 95% CI, 1.8-33.0) having the greatest risk. Survivors also reported higher rates than siblings of overall infectious complications (RR=1.3; 95% CI, 1.2-1.4), and higher rates of all categories of infection. Conclusion Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, with a higher risk of infection-related mortality years following therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.

BACKGROUND Limited data exist on the comprehensive assessment of late medical and social effects experienced by survivors of childhood and young adult acute myeloid leukemia (AML). METHODS This analysis included 272 5‐year AML survivors who participated in the Childhood Cancer Survivor Study (CCSS). All patients were diagnosed at age ≤21 years between the years 1970 and 1986, and none underwent stem cell transplantation. Rates of survival, relapse, and late outcomes were analyzed. RESULTS The average follow‐up was 20.5 years (range, 5–33 years). The overall survival rate was 97% at 10 years (95% confidence interval [95%CI], 94%–98%) and 94% at 20 years (95% CI, 90%–96%). Six survivors reported 8 recurrences. The cumulative incidence of recurrent AML was 6.6% at 10 years (95% CI, 3.7%–9.6%) and 8.6% at 20 years (95% CI, 5.1%–12.1%). Ten subsequent malignant neoplasms (SMN) were reported, including 4 with a history of radiation therapy, for a 20‐year cumulative incidence of 1.7% (95% CI, 0.02%–3.4%). Six cardiac events were reported, for a 20‐year cumulative incidence 4.7% (95% CI, 2.1%–7.3%). Half of the survivors reported a chronic medical condition and, compared with siblings, were at increased risk for severe or life‐threatening chronic medical conditions (16% vs 5.8%; P < .001). Among those aged ≥25 years, the age‐adjusted marriage rates were similar among survivors and the general United States population (57% for both) and lower compared with siblings (67%; P < .01). Survivors' college graduation rates were lower compared with siblings but higher than the general population (40% vs 52% vs 34%, respectively; P < .01). Employment rates were similar between survivors, siblings, and the general population (93%, 97.6%, and 95.8%, respectively). CONCLUSIONS Long‐term survival from childhood AML ≥5‐years after diagnosis was favorable. Late‐occurring medical events remained a concern with socioeconomic achievement lower than expected within the individual family unit, although it was not different from the general United States population. Cancer 2008. © 2008 American Cancer Society.