IMPLICATIONS OF POTENTIAL CURE IN ACUTE MYELOGENOUS LEUKEMIA - DEVELOPMENT OF SUBSEQUENT CANCER AND RETURN TO WORK

Chemotherapy produces extended remissions, and potential cures, in a s mall minority of patients with acute myeloid leukemia (AML). We explor ed whether potentially cured patients were at increased risk of subseq uent invasive cancer and were able to return to work. Potentially cure d patients were defined as those in first or second complete remission (CR) for at least 3 years based on hazard rates for recurrence or dea th in CR, which declined sharply after this time. Patients who receive d allogeneic marrow transplant were excluded. We used questionnaires, phone contact, and chart review to obtain information about subsequent cancer and work status. The number of patients who developed invasive cancer was compared with the number expected based on age, gender, an d years of follow-up using the Connecticut Tumor Registry, A total of 215 patients met our criteria for potential cure: 203 in first CR and 12 in second CR (of 1,663 treated between 1965 and December, 1992). At a median of 9.2 years from first or second CR, 163 (76%) remain alive in CR. Fifteen patients developed 18 invasive cancers (expected numbe r of patients, 8.8: observed/expected, 1.70; 95% CI, 0.96 to 2.84; P = .06). Patients initially treated between 1973 to 1979, patients above the potentially cured cohort's median age of 40 years, and those who p resented with abnormalities of chromosomes 5 and/or 7 were more likely to develop subsequent cancer, whereas the observed/expected ratio for younger patients was 1.05 (95% CI, 0.13 to 3.80; P =.56). Seventy-fou r percent of the patients who were working full-time and who were unde r age 50 at time of treatment for AML have been working full-time in t he last 6 months. Only 17 of 56 patients who are currently not working cited physical limitation as the reason. Patients with potentially cu red AML are likely to be able to return to work, and at least if young er do not, on average, have an increased risk of invasive cancer. (C) 1997 by The American Society of Hematology.