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Long-term survivors of acute lymphoblastic leukaemia

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Current treatment of children with acute lymphoblastic leukaemia (ALL) gives an overall 5-year survival rate of 80–86% and a 5-year event-free survival rate of 78–83%. Some of these survivors will suffer relapse, second cancers, or other complications between 5 and 10 years after first treatment but many will be cured. Now a report from St Jude Children’s Research Hospital in Memphis, Tennessee (

) has illustrated the excellent prognosis for those who survive free of disease for 10 years, especially for those who did not receive central nervous system irradiation.

Between 1962 and 1992 a total of 2069 patients under the age of 21 years with ALL were included in 13 consecutive clinical trials and 1112 survived for at least 10 years. Eight hundred and fifty-six of these (41% of the total) survived free of leukaemia and were followed up for an average of a further 19 years after achieving 10-year survival. Fifty-six of the 856 (6.5%) had major adverse events in the period 10–30 years after first treatment. These were; eight deaths during remission (four from car accidents, two from suicide, one obstetric death, and one of unknown cause), four relapses of leukaemia, and 44 second neoplasms (10 basal cell carcinomas, 10 meningiomas, five malignant brain tumours, two myeloid neoplasms, two soft tissue sarcomas, one Hodgkin’s lymphoma, and 14 other carcinomas). Forty-one of the second neoplasms were related to radiotherapy. The estimated cumulative risk of a second neoplasm in the 20 years after 10-year survival was 21% among patients who had received radiotherapy and 1% among those who had not. Overall mortality in the irradiated group was significantly greater than in the US general population (standardised mortality ratio 1.9) but mortality was not increased significantly in the non-irradiated group. Survivors who did not receive radiotherapy had rates of health insurance coverage, marriage, and employment similar to their US population peers. Among those who had had radiotherapy both men and women had higher than population average rates of unemployment and fewer women were married.

Children with ALL who survive for 10 years free of leukaemia and are not treated with radiotherapy have a normal long-term survival.