Survival Gains in AML Shadowed by Lasting Morbidity

Although survival rates for acute myeloid leukemia (AML) continue to improve, many long-term survivors face persistent physical limitations, high rates of comorbidities, and suboptimal lifestyle behaviors years after diagnosis, according to a new international study.¹

The population of survivors has continued to grow over recent decades,² emphasizing the need to rethink survivorship care models. Traditional approaches have focused heavily on disease monitoring and relapse prevention, but these findings suggest that long-term care should also address physical rehabilitation, comorbidity management, and lifestyle interventions.

The research, published in The Oncologist, analyzed 225 survivors of AML across 24 centers in 6 countries, with a median (IQR) 8.8 years (6.4-11.9) since diagnosis. Investigators assessed health-related quality of life (HRQOL), comorbid conditions, and lifestyle factors to better understand the long-term burden of the disease and its treatment.

Despite advances in treatment and increasing survival rates, survivors of AML reported significantly worse physical health compared with the general population across the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical functioning (Δ = −8.09; 95% CI, –11.47 to –4.72; P < .001) and role physical (Δ = −11.09; 95% CI, –17.04 to –5.14; P < .001) scales. Notably, patients experienced meaningful declines in physical functioning and limitations in daily roles due to physical health. Overall physical health scores were also lower, even years after completing treatment.

Interestingly, mental health outcomes appeared comparable with the general population, suggesting that the long-term burden of AML may be more physical than psychological. However, the researchers cautioned that physical impairments can still indirectly affect emotional and social well-being over time.

The study revealed a striking prevalence of comorbid conditions among survivors of AML. A total of 88.5% of participants reported at least 1 additional health issue, with common conditions including impaired vision (48.2%), back pain (36.2%), arthritis (34.4%), and hypertension (31.2%).

These findings underscore the complexity of survivorship in AML, where patients are not only managing the aftermath of cancer but also a range of chronic health issues that may compound their overall health burden, noted the researchers. Treatment type also appeared to influence long-term outcomes. Patients who underwent allogeneic stem cell transplantation (alloSCT) tended to report worse QOL and higher symptom burden compared with those treated with chemotherapy or autologous transplantation (autoSCT).

“Previous studies have similarly reported lower HRQOL in AML survivors who underwent alloSCT as compared with those who received autoSCT or chemotherapy,” explained the researchers. “However, these studies had shorter follow-up periods. Interestingly, one study with a similar follow-up duration to ours also found worse HRQOL in survivors treated with alloSCT compared to those treated with chemotherapy, although the comparison did not include patients receiving autoSCT.”

Beyond clinical factors, the study identified concerning trends in lifestyle behaviors: 66.6% of survivors were classified as physically inactive, 80% did not meet recommended dietary guidelines, and 55.3% were overweight or obese. Most survivors reported being nonsmokers (83.6%) and limiting alcohol use (95.9%).

Among all variables analyzed, physical inactivity emerged as the only independent factor significantly associated with poorer quality of life (β = –6.3; 95% CI, –10.0 to –2.6; P < .001). Survivors who were less active reported notably worse outcomes, suggesting that exercise and movement may play a critical role in long-term recovery.

Although the study did not establish causation, the findings align with broader oncology research indicating that physical activity can improve symptoms, functional status, and overall well-being in cancer survivors. The researchers called for further research, particularly longitudinal studies, to better understand how interventions such as structured exercise programs could improve quality of life in this population.

References

1. Efficace F, Cannella L, Thomas X, et al. Long-term health-related quality of life and lifestyle behavior of patients with acute myeloid leukemia. Oncologist. 2026;31(4):oyag027. doi:10.1093/oncolo/oyag027
2. Survival rates for AML increase from 1980 to 2017. HealthTree Foundation. June 30, 2021. Accessed March 19, 2026. https://healthtree.org/aml/community/articles/survival-rates-for-aml-increase-from-1980-to-2017