General condition and comorbidity of long-term survivors of adult acute lymphoblastic leukemia
Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in su...
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| Published in | Haematologica (Roma) Vol. 108; no. 7; pp. 1758 - 1767 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Italy
Fondazione Ferrata Storti
01.07.2023
Ferrata Storti Foundation |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0390-6078 1592-8721 1592-8721 |
| DOI | 10.3324/haematol.2022.281820 |
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| Abstract | Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in survivors of adult ALL retrospectively. Physicians answered a questionnaire on general condition (Eastern Cooperative Oncology Group [ECOG] status) and comorbidity or syndrome occurrence observed after treatment. Five hundred and thirty-eight patients with a median age of 29 (range, 15-64) years at diagnosis were analyzed, median follow-up was 7 (range, 3-24) years. Thirty-one percent had received SCT. ECOG status was 0-1 in 94%, 34% had not developed significant comorbidities. Most frequent comorbidities involved the neurologic system (27%), endocrine system (20%), skin (18%), graft-versus-host-disease (15%), cardiac system (13%), fatigue (13%). SCT impacted ECOG status and comorbidity occurrence significantly. ECOG 0-1 was observed in 86% of SCT and 98% of non-SCT patients (P<0.0001); comorbidity was observed in 87% and 57% respectively (P<0.0001). Our analysis elucidates the spectrum of comorbidities in cured adult ALL patients, with higher risk for transplanted patients, providing stimulations for the design of adequate aftercare programs. Overall, a large proportion of non-SCT patients achieved unrestricted general condition. The data provide a reference for new patient-centered endpoints in future trials. |
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| AbstractList | Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in survivors of adult ALL retrospectively. Physicians answered a questionnaire on general condition (Eastern Cooperative Oncology Group [ECOG] status) and comorbidity or syndrome occurrence observed after treatment. Five hundred and thirty-eight patients with a median age of 29 (range, 15-64) years at diagnosis were analyzed, median follow-up was 7 (range, 3-24) years. Thirty-one percent had received SCT. ECOG status was 0-1 in 94%, 34% had not developed significant comorbidities. Most frequent comorbidities involved the neurologic system (27%), endocrine system (20%), skin (18%), graft-versus-host-disease (15%), cardiac system (13%), fatigue (13%). SCT impacted ECOG status and comorbidity occurrence significantly. ECOG 0-1 was observed in 86% of SCT and 98% of non-SCT patients (P<0.0001); comorbidity was observed in 87% and 57% respectively (P<0.0001). Our analysis elucidates the spectrum of comorbidities in cured adult ALL patients, with higher risk for transplanted patients, providing stimulations for the design of adequate aftercare programs. Overall, a large proportion of non-SCT patients achieved unrestricted general condition. The data provide a reference for new patient-centered endpoints in future trials. Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in survivors of adult ALL retrospectively. Physicians answered a questionnaire on general condition (Eastern Cooperative Oncology Group [ECOG] status) and comorbidity or syndrome occurrence observed after treatment. Five hundred and thirty-eight patients with a median age of 29 (range, 15-64) years at diagnosis were analyzed, median follow-up was 7 (range, 3-24) years. Thirty-one percent had received SCT. ECOG status was 0-1 in 94%, 34% had not developed significant comorbidities. Most frequent comorbidities involved the neurologic system (27%), endocrine system (20%), skin (18%), graft-versus-host-disease (15%), cardiac system (13%), fatigue (13%). SCT impacted ECOG status and comorbidity occurrence significantly. ECOG 0-1 was observed in 86% of SCT and 98% of non-SCT patients (P<0.0001); comorbidity was observed in 87% and 57% respectively (P<0.0001). Our analysis elucidates the spectrum of comorbidities in cured adult ALL patients, with higher risk for transplanted patients, providing stimulations for the design of adequate aftercare programs. Overall, a large proportion of non-SCT patients achieved unrestricted general condition. The data provide a reference for new patient-centered endpoints in future trials.Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in survivors of adult ALL retrospectively. Physicians answered a questionnaire on general condition (Eastern Cooperative Oncology Group [ECOG] status) and comorbidity or syndrome occurrence observed after treatment. Five hundred and thirty-eight patients with a median age of 29 (range, 15-64) years at diagnosis were analyzed, median follow-up was 7 (range, 3-24) years. Thirty-one percent had received SCT. ECOG status was 0-1 in 94%, 34% had not developed significant comorbidities. Most frequent comorbidities involved the neurologic system (27%), endocrine system (20%), skin (18%), graft-versus-host-disease (15%), cardiac system (13%), fatigue (13%). SCT impacted ECOG status and comorbidity occurrence significantly. ECOG 0-1 was observed in 86% of SCT and 98% of non-SCT patients (P<0.0001); comorbidity was observed in 87% and 57% respectively (P<0.0001). Our analysis elucidates the spectrum of comorbidities in cured adult ALL patients, with higher risk for transplanted patients, providing stimulations for the design of adequate aftercare programs. Overall, a large proportion of non-SCT patients achieved unrestricted general condition. The data provide a reference for new patient-centered endpoints in future trials. Cure rates in adult acute lymphoblastic leukemia (ALL) improved using pediatric-based chemotherapy and stem cell transplantation (SCT). However, limited data on the health condition of cured adults are available whereas pediatric data cannot be transferred. The GMALL analyzed the health status in survivors of adult ALL retrospectively. Physicians answered a questionnaire on general condition (Eastern Cooperative Oncology Group [ECOG] status) and comorbidity or syndrome occurrence observed after treatment. Five hundred and thirty-eight patients with a median age of 29 (range, 15-64) years at diagnosis were analyzed, median follow-up was 7 (range, 3-24) years. Thirty-one percent had received SCT. ECOG status was 0-1 in 94%, 34% had not developed significant comorbidities. Most frequent comorbidities involved the neurologic system (27%), endocrine system (20%), skin (18%), graft- versus -host-disease (15%), cardiac system (13%), fatigue (13%). SCT impacted ECOG status and comorbidity occurrence significantly. ECOG 0-1 was observed in 86% of SCT and 98% of non-SCT patients ( P <0.0001); comorbidity was observed in 87% and 57% respectively ( P <0.0001). Our analysis elucidates the spectrum of comorbidities in cured adult ALL patients, with higher risk for transplanted patients, providing stimulations for the design of adequate aftercare programs. Overall, a large proportion of non-SCT patients achieved unrestricted general condition. The data provide a reference for new patient-centered endpoints in future trials. |
| Author | Elmaagacli, Ahmet Beck, Joachim Hoelzer, Dieter Ritter, Barbara Viardot, Andreas Heidenreich, Daniela Kreuzer, Karl-Anton Renzelmann, Andrea Serve, Hubert Wäsch, Ralph Topp, Max S. Gökbuget, Nicola Alakel, Nael Westermann, Jörg Raffel, Simon Ihrig, Kristina Stadler, Michael Starck, Michael Stoltefuss, Andrea Hanoun, Maher Reimer, Peter Stelljes, Matthias Wendelin, Knut |
| AuthorAffiliation | 5 Munich Hospital Schwabing, München 15 Evang. Kliniken Essen-Mitte, Essen 3 University of Muenster , Department of Medicine A, Hematology, Oncology and Pneumology, Muenster 10 University Hospital Mannheim , Clinic for Hematology and Oncology, Mannheim 17 Charite University Medicine Berlin , Campus Virchow-Klinikum, Berlin 8 University Hospital of Ulm , Department of Internal Medicine III, Ulm 7 Evangelisches Krankenhaus Hamm, Hamm 16 University Medicine Mainz , Medical Clinic and Polyclinic III, Hematology, Oncology and Pneumonology, Mainz 4 Asklepios Hospital Hamburg St. Georg, Hamburg 1 Goethe University, University Hospital , Department of Medicine II, Hematology/Oncology, Frankfurt 2 Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover 14 Klinikum Kassel, Medical Clinic IV, Oncology, Hematology and Immunology, Kassel 19 University Hospital Dresden , Department I of Internal Medicine, Hematology and Oncology, Dresden 18 Klinikum Nuernb |
| AuthorAffiliation_xml | – name: 15 Evang. Kliniken Essen-Mitte, Essen – name: 4 Asklepios Hospital Hamburg St. Georg, Hamburg – name: 10 University Hospital Mannheim , Clinic for Hematology and Oncology, Mannheim – name: 6 University Hospital , Department of Internal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg – name: 13 University Hospital , Medical Clinic and Polyclinic II, Würzburg – name: 16 University Medicine Mainz , Medical Clinic and Polyclinic III, Hematology, Oncology and Pneumonology, Mainz – name: 9 University at Cologne , Department I of Internal Medicine, Köln – name: 14 Klinikum Kassel, Medical Clinic IV, Oncology, Hematology and Immunology, Kassel – name: 3 University of Muenster , Department of Medicine A, Hematology, Oncology and Pneumology, Muenster – name: 17 Charite University Medicine Berlin , Campus Virchow-Klinikum, Berlin – name: 5 Munich Hospital Schwabing, München – name: 18 Klinikum Nuernberg, Paracelsus Medizinische Privatuniversität, Nuernberg – name: 20 University Hospital , Department of Hematology and Stem Cell Transplantation, Essen, Germany – name: 19 University Hospital Dresden , Department I of Internal Medicine, Hematology and Oncology, Dresden – name: 1 Goethe University, University Hospital , Department of Medicine II, Hematology/Oncology, Frankfurt – name: 8 University Hospital of Ulm , Department of Internal Medicine III, Ulm – name: 7 Evangelisches Krankenhaus Hamm, Hamm – name: 11 University Hospital for Internal Medicine , Oncology and Hematology, Oldenburg – name: 12 University of Freiburg, University Medical Center , Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg – name: 2 Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover |
| Author_xml | – sequence: 1 givenname: Nicola surname: Gökbuget fullname: Gökbuget, Nicola – sequence: 2 givenname: Kristina surname: Ihrig fullname: Ihrig, Kristina – sequence: 3 givenname: Michael surname: Stadler fullname: Stadler, Michael – sequence: 4 givenname: Matthias surname: Stelljes fullname: Stelljes, Matthias – sequence: 5 givenname: Ahmet surname: Elmaagacli fullname: Elmaagacli, Ahmet – sequence: 6 givenname: Michael surname: Starck fullname: Starck, Michael – sequence: 7 givenname: Simon surname: Raffel fullname: Raffel, Simon – sequence: 8 givenname: Andrea surname: Stoltefuss fullname: Stoltefuss, Andrea – sequence: 9 givenname: Andreas surname: Viardot fullname: Viardot, Andreas – sequence: 10 givenname: Karl-Anton surname: Kreuzer fullname: Kreuzer, Karl-Anton – sequence: 11 givenname: Daniela surname: Heidenreich fullname: Heidenreich, Daniela – sequence: 12 givenname: Andrea surname: Renzelmann fullname: Renzelmann, Andrea – sequence: 13 givenname: Ralph surname: Wäsch fullname: Wäsch, Ralph – sequence: 14 givenname: Max S. surname: Topp fullname: Topp, Max S. – sequence: 15 givenname: Barbara surname: Ritter fullname: Ritter, Barbara – sequence: 16 givenname: Peter surname: Reimer fullname: Reimer, Peter – sequence: 17 givenname: Joachim surname: Beck fullname: Beck, Joachim – sequence: 18 givenname: Jörg surname: Westermann fullname: Westermann, Jörg – sequence: 19 givenname: Knut surname: Wendelin fullname: Wendelin, Knut – sequence: 20 givenname: Nael surname: Alakel fullname: Alakel, Nael – sequence: 21 givenname: Maher surname: Hanoun fullname: Hanoun, Maher – sequence: 22 givenname: Hubert surname: Serve fullname: Serve, Hubert – sequence: 23 givenname: Dieter surname: Hoelzer fullname: Hoelzer, Dieter |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36779593$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/S1470-2045(14)70265-7 10.1182/blood.V110.11.849.849 10.1182/blood-2007-10-117150 10.1016/S0959-8049(02)00875-4 10.1038/sj.bjc.6602012 10.1097/HS9.0000000000000544 10.1093/annonc/mdw025 10.1182/blood.V64.1.38.bloodjournal64138 10.1200/JCO.2011.37.3217 10.1002/gps.1042 10.1111/j.1365-2710.2006.00726.x 10.1182/blood.V122.21.839.839 10.1111/bjh.12754 10.1016/S0889-8588(05)70188-X 10.1093/jnci/djt089 10.1046/j.1365-2141.1998.00616.x 10.1007/s00277-019-03771-2 10.1200/JCO.2005.03.210 10.1182/blood.V116.21.494.494 10.1182/blood.V71.1.123.bloodjournal711123 10.1182/asheducation-2014.1.190 10.1038/sj.leu.2404824 10.1200/JCO.2015.65.4574 10.1182/blood.V87.7.3045.bloodjournal8773045 10.1200/JCO.2008.21.1425 10.1046/j.1365-2141.2002.03527.x 10.1200/JCO.2017.77.3648 10.1200/JCO.2008.16.8864 10.1200/JCO.1988.6.4.588 10.3324/haematol.2016.147595 10.1200/JCO.2012.47.0500 10.1038/sj.leu.2405032 10.1200/JCO.2016.68.8457 10.1182/asheducation-2014.1.495 10.1182/blood-2007-03-082933 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Disclosures NG designed the analysis. NG and KI performed the analysis. All authors recruited patients, conducted patient follow-up, and collected clinical data. The manuscript was prepared by NG and KI and all authors participated in data interpretation and drafting of the manuscript and read, revised, and approved the final manuscript. Contributions No conflicts of interest to disclose. All data generated or analyzed during this study are included in this published article (and its Online Supplementary Appendix). Data-sharing statement |
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| SubjectTerms | Acute Lymphoblastic Leukemia Adolescent Adult Child Comorbidity Hematopoietic Stem Cell Transplantation - adverse effects Humans Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy Retrospective Studies Survivors Young Adult |
| Title | General condition and comorbidity of long-term survivors of adult acute lymphoblastic leukemia |
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