Long-Term Outcomes among Adolescent and Young Adult Survivors of Acute Leukemia: A Surveillance, Epidemiology, and End Results Analysis

Abstract

Background: There is a growing population of adolescent and young adult (AYA, age 15–39 years) acute leukemia survivors in whom long-term mortality outcomes are largely unknown. Methods: The current study utilized the Surveillance, Epidemiology, and End Results (SEER) registry to assess long-term outcomes of AYA acute leukemia 5-year survivors. The impact of diagnosis age, sex, race/ethnicity, socioeconomic status, and decade of diagnosis on long-term survival were assessed utilizing an accelerated failure time model. Results: A total of 1,938 AYA acute lymphoblastic leukemia (ALL) and 2,350 AYA acute myeloid leukemia (AML) survivors diagnosed between 1980 and 2009 were included with a median follow-up of 12.3 and 12.7 years, respectively. Ten-year survival for ALL and AML survivors was 87% and 89%, respectively, and 99% for the general population. Survival for AYA leukemia survivors remained below that of the age-adjusted general population at up to 30 years of follow-up. Primary cancer mortality was the most common cause of death in early survivorship with noncancer causes of death becoming more prevalent in later decades of follow-up. Male AML survivors had significantly worse survival than females (survival time ratio: 0.61, 95% confidence interval: 0.45–0.82). Conclusions: AYA leukemia survivors have higher mortality rates than the general population that persist for decades after diagnosis. Impact: While there have been improvements in late mortality, long-term survival for AYA leukemia survivors remains below that of the general population. Studies investigating risk factors for mortality and disparities in late effects among long-term AYA leukemia survivors are needed.

Anticancer Effects of Fucoxanthin through Cell Cycle Arrest, Apoptosis Induction, Angiogenesis Inhibition, and Autophagy Modulation

“…In 2022, The American Cancer Society approximates that there will be around 60,650 new cases and 24,000 deaths due to leukemia in the United States [24]. The 10-year survival rate for patients with leukemia is 87% [25]. There are 1.93 million new cases of colorectal cancer, and 940,000 cases caused death in 2020 worldwide.…”

“…Relative survival rates and percentages by cancer type[15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Toward identification and intervention to address financial toxicity and unmet health‐related social needs among adolescents and emerging adults with cancer and their caregivers: A cross‐cultural perspective

“… 7 , 8 Compared to older cancer survivors, AYAs experience disproportionately higher rates of financial toxicity and unemployment, associated with poorer overall survival and bankruptcy. 2 , 4 , 7 , 9 , 10 , 11 Among AYA survivors in the United States (U.S.), those with public insurance, who live in areas of high deprivation, or who are Black or Hispanic/Latinx (hereafter Hispanic) have lower rates of 5‐ and 10‐year survival, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 likely due in part to adverse social determinants of health (SDOH) and unmet health‐related social needs (HRSN: financial strain, food insecurity, un/underinsurance, unstable housing, and suboptimal education). 20 , 21 , 22 Thus, financial toxicity and HRSN are key contributors to health outcome disparities among AYA survivors.…”

Venetoclax Combination Treatment of Acute Myeloid Leukemia in Adolescents and Young Adult Patients

“…AYAs diagnosed with AML present an overall cure rate ranging from 50% to 60%, with prognosis decreasing with increasing age, independently of other risk factors [21,22]. Interestingly, AYA leukemia survivors present higher mortality rates than the general population, which persists for decades after their diagnosis, despite the improvements in late mortality and long-term survival for AYA hematologic malignancies during the last decade [23]. This can partially be explained by the lack of therapeutic options for refractory or relapsed disease in this age group, which is usually excluded from novel therapeutic agents' clinical trials, mostly because of the rarity of the neoplasms' subtypes and due to ethical considerations as well [24].…”