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PROMISING NEWS IN MALIGNANT HEMATOLOGY
Great Strides in Survivorship
of Childhood Cancer Since
the 1970s
ore refined treatment and modern screening methods have led to improved long-term survival rates
for children and young adults diagnosed with cancer
– particularly those with acute lymphocytic leukemia (ALL) and Hodgkin lymphoma, according to an analysis from
the Childhood Cancer Survivor Study (CCSS). CCSS is a National
Institutes of Health–funded study examining the long-term effects of cancer and its associated therapies on pediatric cancer
survivors diagnosed between 1970 and 1999.
“Fifty years ago, only one in five children would
survive cancer, and today over 80 percent are
alive five years after diagnosis. Yet, these survivors still grow up with increased risk of dying
from late effects, like heart disease and second
cancers,” said lead study author Gregory T.
Armstrong, MD, MSCE, a pediatric oncologist at St. Jude Children’s Research Hospital
in Memphis, Tennessee. “Now, we’ve not only
helped more children survive their primary
cancer, but we’ve also extended their overall
lifespan by reducing the overall toxicity of
treatment in more modern eras.”
In the study, presented as a Late-Breaking
Abstract at the 2015 American Society of Clinical Oncology Annual Meeting, Dr. Armstrong
and colleagues evaluated late mortality in
patients who were younger than 21 years old at
the time of diagnosis. The National Death Index (a central computerized index of death record information on file in the state vital statistics offices) was used to assess mortality among
the more than 34,000 five-year survivors of
CCSS. “Late mortality” was defined as death
due to non-recurrence or non-extend causes,
which included deaths that reflect late effects of
cancer therapy (subsequent neoplasm, cardiac
disease, and pulmonary disease).
Over a median follow-up of 21 years (range,
5-38), 3,958 deaths occurred – 1,622 (41%) of
which were attributable to non-recurrence/
non-extend causes, including:
• 751 subsequent neoplasms deaths
• 243 cardiac disease-related deaths
• 136 pulmonary disease-related deaths
All-cause mortality at 15 years after diagnosis
dropped by half from the early 1970s to the
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ASH Clinical News
early 1990s – from 12.4 percent to 6 percent
(p<0.001). As seen in the TABLE, the cumulative
incidence of deaths from other health-related
causes also decreased.
Reductions in mortality were due to fewer
deaths related to late effects, Dr. Armstrong
and colleagues observed, and were most
striking among survivors of ALL (p<0.001),
Hodgkin lymphoma (p=0.005), and Wilms
tumor (p=0.005).
Year of diagnosis did affect mortality
incidence, with survivors diagnosed in more
recent years having a 15 percent lower risk for
all-cause mortality than patients diagnosed in
earlier treatment eras (relative risk [RR]=0.85;
95% CI 0.83-0.87), including:
• death related to other causes (