Advanced

Late mortality and morbidity among long-term leukemia survivors with Down syndrome : A nationwide population-based cohort study

Vonasek, Julia ; Asdahl, Peter ; Heyman, Mats ; Källén, Karin LU and Hasle, Henrik (2018) In Pediatric Blood & Cancer 65(9).
Abstract

Background: Late health consequences of treatment for childhood leukemia are well documented. Although individuals with Down syndrome (DS) have a substantially increased risk of leukemia, information on late effects in this group is almost nonexistent. The aim of this study was to evaluate the mortality and morbidity among 5-year leukemia survivors with DS. Procedure: We compared 5-year leukemia survivors with leukemia-free individuals with DS. All individuals born with DS in Denmark between 1960 and 2007 and in Sweden between 1973 and 2009 were included. Long-term morbidity was estimated by comparing hospitalization rates between survivors and leukemia-free individuals. Results: In total, we found 6,705 individuals with DS, 84 of whom... (More)

Background: Late health consequences of treatment for childhood leukemia are well documented. Although individuals with Down syndrome (DS) have a substantially increased risk of leukemia, information on late effects in this group is almost nonexistent. The aim of this study was to evaluate the mortality and morbidity among 5-year leukemia survivors with DS. Procedure: We compared 5-year leukemia survivors with leukemia-free individuals with DS. All individuals born with DS in Denmark between 1960 and 2007 and in Sweden between 1973 and 2009 were included. Long-term morbidity was estimated by comparing hospitalization rates between survivors and leukemia-free individuals. Results: In total, we found 6,705 individuals with DS, 84 of whom were 5-year survivors of leukemia. Survivors had a higher risk of death (hazard ratio [HR] 5.9; 95% confidence interval [CI]: 2.7–13) compared with leukemia-free individuals. All deaths (n = 7) among 5-year leukemia survivors were due to relapse. Survivors had a higher hospitalization rate (HR 4.4; 95% CI: 3.1–6.2). However, most of these hospitalizations were due to relapse. Censoring individuals who either had a relapse or were being treated for a relapse more than 5 years from the initial diagnosis (n = 9) attenuated the association (HR 1.4; 95% CI: 1.0–2.1). Conclusion: In this study, we found that relapse was the main reason for death and hospitalization among leukemia survivors with DS, and not late effects. These results are reassuring for individuals treated for DS associated with leukemia and their parents.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Down syndrome, late effects, leukemia, morbidity, mortality
in
Pediatric Blood & Cancer
volume
65
issue
9
article number
e27249
publisher
John Wiley and Sons
external identifiers
  • pmid:29797653
  • scopus:85050376571
ISSN
1545-5009
DOI
10.1002/pbc.27249
language
English
LU publication?
yes
id
c696564e-cad9-459c-ad72-65bbc4ccecf3
date added to LUP
2018-08-15 11:47:37
date last changed
2021-03-03 05:42:04
@article{c696564e-cad9-459c-ad72-65bbc4ccecf3,
  abstract     = {<p>Background: Late health consequences of treatment for childhood leukemia are well documented. Although individuals with Down syndrome (DS) have a substantially increased risk of leukemia, information on late effects in this group is almost nonexistent. The aim of this study was to evaluate the mortality and morbidity among 5-year leukemia survivors with DS. Procedure: We compared 5-year leukemia survivors with leukemia-free individuals with DS. All individuals born with DS in Denmark between 1960 and 2007 and in Sweden between 1973 and 2009 were included. Long-term morbidity was estimated by comparing hospitalization rates between survivors and leukemia-free individuals. Results: In total, we found 6,705 individuals with DS, 84 of whom were 5-year survivors of leukemia. Survivors had a higher risk of death (hazard ratio [HR] 5.9; 95% confidence interval [CI]: 2.7–13) compared with leukemia-free individuals. All deaths (n = 7) among 5-year leukemia survivors were due to relapse. Survivors had a higher hospitalization rate (HR 4.4; 95% CI: 3.1–6.2). However, most of these hospitalizations were due to relapse. Censoring individuals who either had a relapse or were being treated for a relapse more than 5 years from the initial diagnosis (n = 9) attenuated the association (HR 1.4; 95% CI: 1.0–2.1). Conclusion: In this study, we found that relapse was the main reason for death and hospitalization among leukemia survivors with DS, and not late effects. These results are reassuring for individuals treated for DS associated with leukemia and their parents.</p>},
  author       = {Vonasek, Julia and Asdahl, Peter and Heyman, Mats and Källén, Karin and Hasle, Henrik},
  issn         = {1545-5009},
  language     = {eng},
  month        = {09},
  number       = {9},
  publisher    = {John Wiley and Sons},
  series       = {Pediatric Blood & Cancer},
  title        = {Late mortality and morbidity among long-term leukemia survivors with Down syndrome : A nationwide population-based cohort study},
  url          = {http://dx.doi.org/10.1002/pbc.27249},
  doi          = {10.1002/pbc.27249},
  volume       = {65},
  year         = {2018},
}