Purpose: To investigate the incidence of and risk factors for late sequelae
of treatment in patients who survived far more than 10 years after the dia
gnosis of childhood acute myeloid leukemia (AML).
Patients and Methods: Of 77 survivors (median follow-up duration, 16.7 year
s), 44 (group A) had received chemotherapy, 18 (group B) had received chemo
therapy and cranial irradiation, and 15 (group C) had received chemotherapy
, total-body irradiation, and allogeneic bone marrow transplantation. Late
complications, tabacco use, and health insurance status were assessed.
Results: Growth abnormalities were found in 51% of survivors, neurocognitiv
e abnormalities in 30%, transfusion-acquired hepatitis in 28%, endocrine ab
normalities in 16%, cataracts in 12%, and cardiac abnormalities in 8%. Youn
ger age at the rime of diagnosis or initiation of radiation therapy, higher
dose of radiation, and treatment in groups B and C were risk factors for t
he development of academic difficulties and greater decrease in height Z sc
ore, In addition, treatment in group C was a risk factor for ct greater dec
rease in weight I score and the development of growth-hormone deficiency, h
ypothyroidism, hypogonadism, infertility, and cataracts. The estimated cumu
lative risk of ct second malignancy at 20 years after diagnosis was 1.8% (9
5% confidence interval, 0.3% to 11.8%). Twenty-two patients (29%) were smok
ers, and 11 (14%) had no medical insurance at the time of last follow-up.
Conclusion: Late sequelae are common in long-term survivors of childhood AM
L. Our findings should be useful in defining areas for surveillance of and
intervention for late sequelae and in assessing the risk of individual late
effects on the basis of age and history of treatment. (C) 2000 by American
Society of Clinical Oncology.