New Meaning of 'Cured' for Leukemia
10 Years Without Relapse=Cured Case of Acute Lymphoblastic Leukemia
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
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
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
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.