Leukemia Research 37 (2013) 1632–1635 Contents lists available at ScienceDirect Leukemia Research journa l h o me pag e: www.elsevier.com/locate/leukres Quality of life following completion of treatment for adult acute lymphoblastic leukemia with a pediatric-based protocol Elena Liew a , Santhosh Thyagu a , Eshetu G. Atenafu b , Shabbir M.H. Alibhai c , Joseph M. Brandwein a,∗ a Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada b Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada c Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada a r t i c l e i n f o Article history: Received 12 July 2013 Received in revised form 16 September 2013 Accepted 19 September 2013 Available online 27 September 2013 Keywords: Acute lymphoblastic leukemia Leukemia Quality of life Chemotherapy a b s t r a c t Using multiple validated self-report instruments, we evaluated the health-related quality of life (HRQoL) of 29 adult ALL patients a median of 28 months after completing a pediatric-based treatment regimen. Global health was similar to normative data, but leukemia survivors had lower cognitive and social func- tion, and reported more financial difficulty. Fatigue and pain affected 83% and 53% of patients, respectively, and both showed significant inverse correlation with overall health and all functional scales. Vincristine- related peripheral neuropathy was reported by 43%. Although therapy-related symptoms were persistent, long-term ALL survivors have a global HRQoL similar to the general population. © 2013 Elsevier Ltd. All rights reserved. 1. Introduction Health-related quality of life (HRQoL) is a multidimensional construct that encompasses several domains: physical, cognitive, social, and emotional functioning [1,2]. As developments in oncol- ogy treatment have improved patient survival, HRQoL has become recognized as an important outcome, and it has been increasingly incorporated as an endpoint in clinical trials [3]. While a large body of research on survivorship exists for solid tumor malignancies, this has been an understudied area among adults with leukemia [3,4]. Acute lymphoblastic leukemia (ALL) accounts for approxi- mately 20% of acute leukemias in adults. Treatment outcomes in adults have been generally inferior to those of pediatric patients. The use of pediatric-based protocols in the management of adult ALL appears to improve survival, particularly in young adults, with long-term survival in the range of 60–80% [5]. These protocols incorporate higher cumulative doses of asparaginase, vincristine, and corticosteroids compared to adult-based regimens. The dura- tion of treatment usually spans a period of 2–3 years, during which time significant treatment-related toxicities can develop, including ∗ Corresponding author at: Division of Hematology, Department of Medicine, Uni- versity of Alberta, 4-112 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, Canada T6G 2G3. Tel.: +1 780 407 7482; fax: +1 780 407 2680. E-mail address: jbrandwe@ualberta.ca (J.M. Brandwein). osteonecrosis and peripheral neuropathy. These are potentially disabling and can adversely affect HRQoL; however, the long-term impact of pediatric-based regimens on HRQoL in adults has not previously been reported. We therefore aimed to assess HRQoL using psychometrically validated self-report instruments in long-term survivors of adult ALL following completion of a modified pediatric protocol used as standard frontline treatment at our institution. 2. Methods Patients were recruited from the Leukemia Service at Princess Margaret Can- cer Centre (Toronto, Ontario, Canada), and were eligible to participate if they were 18 years of age or older, had a diagnosis of ALL, and remained in continuous first complete remission at least 3 months after completion of the modified Dana Far- ber Cancer Institute (DFCI) 91-01 pediatric protocol, which has been previously described [6]. In addition, patients were required to have adequate fluency in English to complete self-administered questionnaires. None of the participants had undergone bone marrow transplantation as part of their treatment. Demographic, disease, and treatment information were obtained through a patient chart review. All patients provided informed consent for study participation. Ethics approval for this study was obtained from the University Health Network Research Ethics Board. 2.1. Outcome measures The European Organization for the Research and Treatment of Cancer (EORTC) quality of life core 30-item questionnaire (QLQ-C30) features a global health mea- sure, 5 functional scales (physical, role, cognitive, emotional, and social), and several symptom scales/items [7]. Scores are scaled from 0 to 100; higher scores in the global measure and functional scales represent better functional status and HRQoL. 0145-2126/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.leukres.2013.09.018