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New Meaning of 'Cured' for Leukemia

10 Years Without Relapse=Cured Case of Acute Lymphoblastic Leukemia
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Aug. 13, 2003 -- People who survive the most common type of childhood cancer, acute lymphoblastic leukemia (ALL), should be considered cured if they've gone 10 years or more without a relapse of the disease or other complications, according to a new study.

Acute lymphoblastic leukemia usually strikes about 2,500 young children each year, but it may also affect adults.

About 80% of ALL cases are cancer-free five years after treatment. Most of these patients are considered cured, but a substantial number may suffer a relapse of leukemia, a second cancer, or other treatment-related complications.

For these reasons, researchers say that long-term survivors of acute lymphoblastic leukemia are commonly perceived as having a higher risk of cancer or other diseases, which can lead to the denial of life insurance or health coverage, restricted coverage or higher costs for coverage.

Long-Term Prospects for ALL Survivors

In this study, published in TheNew England Journal of Medicine, researchers examined the long-term prospects for normal survival among 856 people with acute lymphoblastic leukemia who had had at least 10 years of remission after undergoing treatment between 1962 and 1992.

The study found children with ALL who did not receive radiation therapy and had reached 10 or more years of cancer-free survival can expect normal long-term survival. The death rates among this group did not differ from the rates expected in the normal population.

However, patients who were treated with radiation, which was used more widely in the past, had a slightly higher risk of death than the normal population and were more likely to develop a secondary cancer.

Researchers say those results support a new working definition of cure -- "10 or more years of continuous complete remission" for persons with ALL.

The disease causes the body to rapidly produce too many functionless infection-fighting white blood cells called lymphocytes, which accumulate in the bones and blood. This accumulation makes bone marrow less capable of producing normal cells, which in turn causes an inability to fight infection.

Quality of Life Also Affected

Researcher Ching-Hon Pui, MD, of the St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues also found that rates of health insurance coverage, marriage, and employment among those who were not treated with radiation were similar to national averages.

But men and women in the irradiated group had higher than normal unemployment rates, despite having normal health insurance rates. Women who had received radiation treatments were also less likely to be married then their healthy peers.

Researchers say those negative quality-of-life factors as well as slightly higher death rates among people treated with radiation lend support to current efforts to limit the use of radiation to treat ALL.

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