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November 9, 1994

Educational Attainment in Long-term Survivors of Childhood Acute Lymphoblastic Leukemia

Author Affiliations

From the Clinical Epidemiology Branch (Drs Haupt and Nicholson) and Biostatistics Branch (Dr Fears) of the National Cancer Institute, and Epidemiology Branch of the National Institute of Child Health and Human Development (Dr Mills), National Institutes of Health, Bethesda, Md; the Department of Hematology/ Oncology, Children's National Medical Center, Washington, DC (Drs Nicholson and Byrne); the Children's Hospital of Philadelphia (Pa) (Dr Meadows); the Department of Pediatrics, University of Minnesota, Minneapolis (Dr Robison); and the Department of Pediatrics, UCLA Medical Center, Los Angeles, Calif (Dr Zeltzer). Dr Haupt is now with the Department of Pediatric Hematology/Oncology, G. Gaslini Children's Hospital, Genoa, Italy.

JAMA. 1994;272(18):1427-1432. doi:10.1001/jama.1994.03520180051034

Objective.  —To determine the impact of treatment on scholastic performance in the first cohort of survivors of childhood acute lymphoblastic leukemia who are old enough to have completed their educational experience.

Design.  —Retrospective cohort study.

Setting.  —Twenty-three institutions in the Childrens Cancer Group.

Subjects.  —A total of 593 adult survivors of childhood acute lymphoblastic leukemia and 409 sibling controls.

Outcome Measures.  —Enrollment in special programs, grades during high school, graduation from high school, college admission, and college graduation.

Results.  —After diagnosis, survivors were more likely than their sibling controls to enter a special education (relative risk [RR] =3.4; P<.01) or a learning disabled (RR=3.6; P<.01 ) program, while just as likely to enter gifted and talented programs (RR=1.0). The risk associated with special education and learning disabled programs increased with increasing dose of cranial radiotherapy. Despite these problems, survivors generally had the same probability as their siblings of finishing high school, entering college, and earning a bachelor's degree. However, survivors treated with 24 Gy and those diagnosed before 6 years of age were less likely to enter college (RR=0.67 and 0.6, respectively; P<.01).

Conclusions.  —This large study demonstrates that childhood acute lymphoblastic leukemia survivors have a greater likelihood of being placed in special education or learning disabled programs than their siblings, but that most are able to overcome these problems. Dose of cranial radiotherapy and age at diagnosis are the most important education-related risk factors.(JAMA. 1994;272:1427-1432)