Health Status and Quality of Life of Long-term Survivors of Childhood Acute Leukemia: The Impact of Central Nervous System Irradiation

We evaluated the impact of central nervous system irradiation (CNSI) on long-term health status and quality of life (QoL) of childhood lymphoblastic leukemia survivors included in the French L.E.A. (Childhood and Adolescent Leukemia) multicentric cohort. QoL was self-reported in adults and assessed by parents in children and adolescents, using adapted questionnaires. From 2004 to 2009, 630 nongrafted patients were assessed after 11.8 +/- 6.3 years from diagnosis. Patients receiving CNSI (18.6%) or chemotherapy alone (81.4%) were compared. The risk of having long-term physical effects was increased with CNSI (odds ratio = 3.3; 95% confidence interval, 1.8-5.9), especially regarding growth failure, second tumor, cataract, and overweight. QoL did not differ significantly according to the treatment received, despite a tendency toward lower scores with CNSI in children and adolescents (summary score 63.6 +/- 13.3 vs. 71.7 +/- 12.4, P = 0.14). Compared with French norms, adult survivors had an impaired QoL, especially in mental domains (mental composite score 45.2 +/- 9.8 vs. 47.9 +/- 2.1, P < 0.001). In pediatric survivors, QoL was not impaired and even tended to be higher than population norms (summary score 71.7 +/- 12.4 vs. 70.0 +/- 4.2, P = 0.054), mainly in social and relational domains. In conclusion, QoL seems to be impaired by the trauma of a life-threatening illness in childhood, as well as by the treatment received.