Academic Difficulties and Occupational Outcomes of Adult Survivors of Childhood Leukemia Who Have Undergone Allogeneic Hematopoietic Stem Cell Transplantation and Fractionated Total Body Irradiation Conditioning

• Published in: Pediatric hematology and oncology Vol. 31; no. 3; pp. 225 - 236
• Main Authors: Freycon, Fernand, Trombert-Paviot, Béatrice, Casagranda, Léonie, Frappaz, Didier, Mialou, Valérie, Armari-Alla, Corinne, Gomez, Frederic, Faure-Conter, Cécile, Plantaz, Dominique, Berger, Claire
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01.04.2014; Taylor & Francis
• Subjects: academic delay; Adolescent; Adult; allogeneic hematopoietic stem cell transplantation; Child; Child, Preschool; childhood leukaemia; Combined Modality Therapy; Dose Fractionation; employment; Employment - statistics & numerical data; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Infant; Learning Disorders - diagnosis; Learning Disorders - etiology; Leukemia - therapy; Male; Myelodysplastic Syndromes - therapy; Prognosis; Survival Rate; Survivors; total body irradiation; Transplantation Conditioning; Transplantation, Homologous; Whole-Body Irradiation - adverse effects; Young Adult
• ISSN: 0888-0018; 1521-0669; 1521-0669
• DOI: 10.3109/08880018.2013.829541

We studied academic and employment outcomes in 59 subjects who underwent allogeneic hematopoietic stem cell transplantation (a-HSCT) with fractionated total body irradiation (fTBI) for childhood leukemia, comparing them with, first, the general French population and, second, findings in 19 who underwent a-HSCT with chemotherapy conditioning. We observed an average academic delay of 0.98 years among the 59 subjects by Year 10 of secondary school (French class Troisième), which was higher than the 0.34-year delay in the normal population (P < .001) but not significantly higher than the delay of 0.68 years in our cohort of 19 subjects who underwent a-HSCT with chemotherapy. The delay was dependent on age at leukemia diagnosis, but not at fTBI. This delay increased to 1.32 years by the final year of secondary school (Year 13, Terminale) for our 59 subjects versus 0.51 years in the normal population (P = .0002), but did not differ significantly from the 1.08-year delay observed in our cohort of 19 subjects. The number of students who received their secondary school diploma (Baccalaureate) was similar to the expected rate in the general French population for girls (observed/expected = 1.02) but significantly decreased for boys (O/E = 0.48; CI: 95%[0.3-0.7]). Compared with 13.8% of the general population, 15.3% of the cancer survivors received no diploma (P = NS). Reported job distribution did not differ significantly between our cohort of childhood cancer survivors and the general population except that more female survivors were employed in intermediate-level professional positions. Academic difficulties after fTBI are common and their early identification will facilitate educational and professional achievement.