Health-related quality of life (HR-QOL) and chronic health conditions (CHC) in survivors of childhood acute myelogenous leukemia (AML)

Abstract

6590 Background: AML therapy has included chemotherapy with or without autologous stem cell transplantation or allogeneic hematopoietic stem cell transplantation (chemo±auto or alloBMT) based on the availability of a matched sibling donor. This allows unbiased comparison of HR-QOL outcomes between these groups. Methods: We surveyed 207 survivors of AML diagnosed before age 21 and treated from 1979 to 1995 on one of 4 COG protocols who survived ≥5 years from diagnosis. Survivors or proxy caregivers completed a CCSS baseline questionnaire and an age-appropriate measure of HR-QOL (SF-36, CHQ-87 or CHQ-PF50). Survivors with Down syndrome were excluded for this analysis. Results: Of the 182 survivors in this analysis, 128 underwent chemo±auto and 54 underwent alloBMT. Median age at diagnosis was 4 years (range, 0 to 20); median age at enrollment was 20 (range 8 to 39). HR-QOL scores were similar among groups and to the normative population (Physical component score: chemo±auto mean 50.8 vs. alloBMT 49.7, p=0.43; mental component score: chemo±auto 49.8 vs. alloBMT 52.0, p=0.20; normative score 50, SD 10). Differences remained insignificant in adjusted analyses. For children ages 12–13 years and children ages 11 and younger, scores were also similar among groups. With regard to chronic health conditions (CHC), in the chemo±auto group, 47% had at least one CHC compared with 76% in the alloBMT group (OR: 3.5, 95% CI: 1.6- 7.6). Twenty-one percent had a severe or life-threatening CHC (chemo±auto16% vs. 33% alloBMT; OR 2.6, 95% CI: 1.2–5.7). One-fourth had ≥3 CHC (chemo±auto17% vs. 40% alloBMT: OR: 3.2, 95% CI: 1.5–7.0). Nearly all (95%) reported that their health was excellent, very good or good. Less than 10% in each group reported activity limitations, functional impairment and/or cancer-related pain. Conclusions: Scores on the HR-QOL measures were similar between treatment groups; however, alloBMT survivors reported more frequent and severe chronic health conditions. No significant financial relationships to disclose.