EDUCATIONAL-ATTAINMENT IN LONG-TERM SURVIVORS OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA

Objective.-To determine the impact of treatment on scholastic performa nce in the first cohort of survivors of childhood acute lymphoblastic leukemia who are old enough to have completed their educational experi ence. Design.-Retrospective cohort study. Setting.-Twenty-three instit utions in the Childrens Cancer Group. Subjects.-A total of 593 adult s urvivors of childhood acute lymphoblastic leukemia and 409 sibling con trols. Outcome Measures.-Enrollment in special programs, grades during high school, graduation from high school, college admission, and coll ege graduation. Results.-After diagnosis, survivors were more likely t han their sibling controls to enter a special education (relative risk [RR] =3.4; P<.01) or a learning disabled (RR=3.6; P<.01) program, whi le just as likely to enter gifted and talented programs (RR=1.0). The risk associated with special education and learning disabled programs increased with increasing dose of cranial radiotherapy. Despite these problems, survivors generally had the same probability as their siblin gs of finishing high school, entering college, and earning a bachelor' s degree. However, survivors treated with 24 Gy and those diagnosed be fore 6 years of age were less likely to enter college (RR=0.67 and 0.6 , respectively; P<.01). Conclusions.-This large study demonstrates tha t childhood acute lymphoblastic leukemia survivors have a greater like lihood of being placed in special education or learning disabled progr ams than their siblings, but that most are able to overcome these prob lems. Dose of cranial radiotherapy and age at diagnosis are the most i mportant education-related risk factors.