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Int J Cancer. 2016 Jan 15;138(2):332-9. doi: 10.1002/ijc.29708. Epub 2015 Sep 3.

Prospective, longitudinal assessment of quality of life in children from diagnosis to 3 months off treatment for standard risk acute lymphoblastic leukemia: Results of Children's Oncology Group study AALL0331.

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Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT.
Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainsville, FL.
Department of Pediatrics, Columbia University, New York, NY.
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatric Oncology, Cancer Institute, New York University Medical Center, New York, NY.
Department of Pediatrics, University of Utah, Salt Lake City, NY.
Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, TX.
Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA.
Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.


Standard risk acute lymphoblastic leukemia (SR-ALL) has high cure rates, but requires 2-3 years of therapy. We aimed to (i) prospectively evaluate health-related quality of life (HRQOL) during and after SR-ALL therapy, and (ii) identify associated predictors. Parents of 160 SR-ALL patients enrolled on Children's Oncology Group (COG) therapeutic trial AALL0331 at 31 sites completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales (physical, emotional and social functioning) and Family Assessment Device-General Functioning (FAD-GF) at 1, 6 and 12 months after diagnosis, and 3 months post-therapy. Mean PedsQL scores in physical, emotional and social functioning were impaired 1 month after diagnosis but steadily improved. Three months post-therapy, impaired physical and social functioning was observed in 27.8 and 25.8% of patients, respectively. In repeated-measures analysis, problematic family functioning predicted emotional (OR = 1.85, 95% CI 1.03-3.34) and social (OR = 1.99, 95% CI 1.21-3.27) impairment. Larger household size was associated with social impairment (OR = 1.21, 95% CI 1.02-1.45). Adverse neurological event(s) during therapy predicted post-therapy physical (OR = 5.17, 95% CI 1.61-16.63) and social (OR = 8.17, 95% CI 1.19-56.16) impairment. HRQOL 1 month after diagnosis was not predictive of HRQOL 3 months after therapy completion. In conclusion, children with SR-ALL experience considerable impairment in HRQOL at the end of induction, but rapidly improve. However, many still experience physical and social impairment 3 months post-therapy, suggesting a role for continued family and physical functioning support. Longer follow-up is needed to determine if post-therapy deficits change over time.


acute lymphoblastic leukemia; childhood leukemia; late effects; physical functioning; quality of life

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