Study Suggests AYAs Treated for AML Have High Risk of Developing Long-Term Complications

Study results published in the International Journal of Epidemiology suggested that adolescent and young adult (AYA) patients treated for acute myeloid leukemia (AML) have a high risk of developing long-term health complications.¹

The most common complications, or late effects as they are referred to in the study, observed among AYA survivors in this study were cardiovascular, endocrine, and respiratory diseases. Moreover, these complications were found to be more prevalent among non-white AYA patients and those living in more impoverished communities.

“Our study shed light on the high burden of late effects among young survivors of AML,” lead author Renata Abrahão, MD, MSc, PhD, a postdoctoral fellow at the UC Davis Comprehensive Cancer Center and the Center for Healthcare Policy and Research, said in a press release.²

To estimate the cumulative incidence and investigate the main predictors of late effects among this patient population, researchers identified 1168 eligible AYAs with AML who survived at least 2 years after diagnosis from 1996 to 2012 in the California Cancer Registry. Importantly, late effects were reported from State hospital discharge data, and patients were followed through 2014.

Ultimately, the most common late effects reported at 10 years after diagnosis were endocrine (26.1%), cardiovascular (18.6%), and respiratory (6.6%), followed by neurologic (4.9%), liver/pancreatic (4.3%), renal (3.1%), avascular necrosis (2.7%), and second primary malignancies (2.4%). Moreover, of the total study cohort, 547 (46.8%) received a hematopoietic stem cell transplant (HSCT).

Following multivariable adjustments, the investigators found that AYAs who underwent HSCT or had non-favorable risk AML experienced an approximately 2-fold or higher increased likelihood of all late effects. Additionally, AYAs of Hispanic, Black, or Asian/Pacific Islander race or ethnicity and those who resided in lower socio-economic neighborhoods were shown to be at higher risk of numerous late effects when compared with non-Hispanic White patients.

“This higher risk may relate to the financial hardship that patients with cancer often experience,” senior author Theresa Keegan, PhD, MS, associate professor at the UC Davis Comprehensive Cancer Center, said in a press release. “As a result of cancer, AYA survivors and their families may miss work, experience income loss, and incur substantial out-of-pocket expenses.”

According to the researchers, many factors may have led to the observed disparities in disease burden. These include differences in therapeutic management, patient’s response to treatment, AML with high-risk mutations, coexisting diseases, and socioeconomic factors.

Further, compared to younger or older cancer survivors, the investigators indicated AYA patients suffer a higher financial burden. They may go without treatment and long-term follow-up visits that could mitigate the impact of late effects. Moreover, their risk of late effects may be exacerbated by unhealthy lifestyle habits such as smoking, excessive alcohol consumption, lack of exercise, non-protected sun exposure, and poor diet.

“Our findings underscore the need for long-term surveillance for the prevention, early detection and treatment of late effects, and can inform the development of AYA-focused consensus-based guidelines that will ultimately improve the quality of life and survival of these young vulnerable patients,” the study authors wrote.

References:

1. Abrahão R, Huynh JC, Benjamin DJ, et al. Chronic medical conditions and late effects after acute myeloid leukaemia in adolescents and young adults: a population-based study. International Journal of Epidemiology. doi: 10.1093/ije/dyaa184

2. Young survivors of acute myeloid leukemia have long-term complications from treatment [news release]. Published November 9, 2020. Accessed November 17, 2020. https://www.newswise.com/articles/young-survivors-of-acute-myeloid-leukemia-have-long-term-complications-from-treatment?sc=sphr&xy=10019792