Abstract

Childhood and adolescent AML requires intensive therapy. Beginning in 1979, the Childrens Cancer Group (CCG) randomized patients with newly-diagnosed AML to allogeneic bone marrow transplantation (alloBMT) based solely on the availability of an HLA-identical sibling donor. Two decades of successive CCG trials using a similar design have shown a significant survival advantage for alloBMT. To determine whether BMT was associated with a diminished quality of life (QOL) in long-term survivors compared to those who had been treated with chemotherapy alone (chemo), we conducted a cross-sectional telephone survey study of AML survivors. To be eligible, survivors must have been enrolled on a CCG AML study (beginning in 1979), have survived at least five years, and reside in the US or Canada. QOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) and the Child Health Questionnaire (CHQ). 206 survivors completed the study, including 124 treated with chemo, 54 treated with alloBMT and 28 treated with autologous BMT (autoBMT). Median age at diagnosis was 3 years (range, 0–20), median age at survey was 19 years (range 8–39) and median time from diagnosis was 13.4 years. 48% were male, and 87% were white. QOL summary scores for the 82 survivors treated with BMT did not differ from those of the 124 treated with chemo (see table). Also, the adjusted summary scores did not differ by treatment after adjustment for other factors, such as age at diagnosis, race, gender, relapse, etc. None of the physical or mental SF-36 or CHQ subscale domains significantly differed by treatment, although physical subscale domains trended to be better in the chemo group. Multivariate analyses found that females had significantly lower physical and mental scores, that relapse significantly diminished the physical summary score, and that age at diagnosis was positively and significantly associated with higher mental summary score. Our data suggest that survivors of childhood and adolescent AML have similar overall QOL scores, regardless of whether they were treated with BMT or chemo. In addition, the QOL scores in most physical and mental health domains were high, suggesting that AML survivors as a group enjoyed good QOL. These data suggest that QOL in long-term survivors is not diminished by BMT and that the primary concern in assigning treatment remains survival.

QOL Summary Scores

TreatmentPhysical ScoreMental Score
 Mean 95% CI p-value Mean 95% CI p-value 
All 49.3 (48.0,50,7)  49.9 (48.4,51.3)  
BMT (n=82) 49.0 (46.8,51.1) 0.68 51.3 (49.0,53.6) 0.11 
Chemo (n=124) 49.6 (47.8,51.3)  48.9 (47.0,50.8)  
TreatmentPhysical ScoreMental Score
 Mean 95% CI p-value Mean 95% CI p-value 
All 49.3 (48.0,50,7)  49.9 (48.4,51.3)  
BMT (n=82) 49.0 (46.8,51.1) 0.68 51.3 (49.0,53.6) 0.11 
Chemo (n=124) 49.6 (47.8,51.3)  48.9 (47.0,50.8)  

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