Risk of early death after acute leukemia diagnosis among adolescents and young adults

Advances in care have led to improvements in survival for adolescents and young adults (AYAs) diagnosed with cancer; however, the risk of early death remains high for certain cancers, particularly acute leukemias. Risk factors for early death in AYAs diagnosed with acute leukemia have not been well studied.

The Surveillance, Epidemiology, and End Results registry was used to assess risk of early death (within 2 months of diagnosis) in AYAs diagnosed with acute leukemia (n = 16 153). Early death proportion, by year, for AYAs diagnosed between 2006 and 2020 was described. Associations between incidence of early death and age at diagnosis, sex, race and ethnicity, socioeconomic status, rurality, acute leukemia type, and year of diagnosis were evaluated with logistic regression.

Overall, 6.0% of AYAs experienced early death and there was a significant annual decrease in the odds of early death (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95 to 0.98, P < .0001) across the study period. Over the entire study period, AYAs diagnosed with acute promyelocytic leukemia (9.6%, 95% CI = 8.4 to 11.1) or other acute leukemias (13.3%, 95% CI = 10.5 to 16.7) had the highest proportion of early death and AYAs diagnosed with T lymphoblastic leukemia/lymphoma had the lowest (2.6%, 95% CI = 1.9 to 3.7). Older age at diagnosis, male sex, and Hispanic ethnicity were all associated with increased risk of early death.

A high proportion of AYAs with acute leukemia experience early death and risk varies by leukemia type and sociodemographic factors. A better understanding of the complex interplay between disease biology and sociodemographic factors is needed to guide risk prediction and prevention.