Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.
Department of Pediatrics and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Pediatr Blood Cancer. 2024 Dec;71(12):e31361. doi: 10.1002/pbc.31361. Epub 2024 Oct 7.
The diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) may impact mental health. We investigated the long-term risk of psychiatric disorders among survivors of ALL in a population-based cohort study.
We identified patients diagnosed with ALL in Denmark and Sweden before age 20 during 1982-2008. Survivors of ALL (n = 2026), their siblings (n = 3027), and population comparison subjects (n = 9713) were followed for hospital contacts for psychiatric disorders from 5 years after ALL diagnosis (or corresponding index date) until 2017.
By age 30, the absolute risk of psychiatric hospital contacts was 19.9% (95% confidence interval [CI]: 17.9-22.1) for ALL survivors, 18.5% (95% CI: 16.9-20.2) for siblings, and 18.3% (95% CI: 17.3-19.2) for population comparison subjects. Overall, survivors were at higher risk of any psychiatric disorders than siblings (hazard ratio [HR] = 1.25; 95% CI: 1.04-1.50), and population comparison subjects (HR = 1.20; 95% CI: 1.06-1.35). The subgroup of survivors (n = 332) who received a hematopoietic stem cell transplantation (HSCT) and/or had a relapse were at highest risk of psychiatric disorders (HR = 2.07; 95% CI: 1.26-3.41 compared to siblings; HR = 1.67; 95% CI: 1.25-2.23 compared to population comparison subjects).
The overall absolute risk of psychiatric hospital contacts among ALL survivors was close to that in siblings and population comparison subjects. The modestly increased relative risk was mainly driven by the subgroup of survivors who received HSCT and/or had a relapse. Our findings are reassuring for the large subgroup of ALL survivors without HSCT or relapse, and provide novel insight on both absolute and relative risk of hospital contacts for psychiatric disorders.
儿童急性淋巴细胞白血病（ALL）的诊断和治疗可能会影响心理健康。我们在一项基于人群的队列研究中调查了 ALL 幸存者的长期精神疾病风险。
我们在丹麦和瑞典确定了 1982-2008 年期间 20 岁以下 ALL 诊断患者。ALL 幸存者（n=2026）、他们的兄弟姐妹（n=3027）和人群对照受试者（n=9713）在 ALL 诊断后 5 年（或相应的索引日期）至 2017 年期间，根据精神病院就诊记录来随访精神疾病情况。
到 30 岁时，ALL 幸存者的精神病院就诊绝对风险为 19.9%（95%置信区间[CI]：17.9-22.1），兄弟姐妹为 18.5%（95% CI：16.9-20.2），人群对照受试者为 18.3%（95% CI：17.3-19.2）。总体而言，幸存者患任何精神疾病的风险均高于兄弟姐妹（风险比[HR] = 1.25；95% CI：1.04-1.50）和人群对照受试者（HR = 1.20；95% CI：1.06-1.35）。接受造血干细胞移植（HSCT）和/或复发的幸存者亚组（n=332）的精神疾病风险最高（与兄弟姐妹相比，HR=2.07；95% CI：1.26-3.41；与人群对照受试者相比，HR=1.67；95% CI：1.25-2.23）。
ALL 幸存者的精神病院就诊绝对风险接近兄弟姐妹和人群对照受试者。适度增加的相对风险主要由接受 HSCT 和/或复发的幸存者亚组驱动。我们的发现为未接受 HSCT 或复发的 ALL 幸存者的大亚组提供了令人安心的结果，并提供了精神疾病住院就诊的绝对和相对风险的新见解。
