Survivors of adolescent and young adult (AYA) hematologic malignancies have a high risk of chronic medical conditions. We evaluated the cumulative incidence and incidence rate ratio (IRR) for several conditions in cancer survivors compared to a matched cohort without cancer.

We used data from Kaiser Permanente (KP) Northern and Southern California to identify AYAs diagnosed at age 15–39 years with Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), acute myeloid leukemia (AML), or acute lymphoblastic leukemia (ALL), from 2006–2020, who survived ≥ 2 years after diagnosis. KP members without a history of cancer were matched (10:1) to survivors by age, sex, diagnosis year, and KP site. We calculated the cumulative incidence of each condition, accounting for death as a competing risk. Multivariable-adjusted Poisson regression estimated rate ratios in survivors versus the matched cohort, adjusting for age at diagnosis, sex, and race/ethnicity.

Among 2,624 AYAs with hematologic malignancies (42% HL, 40% NHL, 9% AML, 9% ALL), with a median follow-up of 5.9 years (interquartile range: 3.7–9.3), the 10-year cumulative incidence was 43.9% for any chronic medical condition (vs. 22.4% in the matched cohort) and 16.1% for ≥ 2 conditions (versus 4.4%). Overall, after adjusting for demographic factors, cancer survivors had 2.7- and 4.8-times higher rates of developing 1 and ≥ 2 conditions, respectively (IRR=2.7, 95% CI 2.5–2.9 and 4.8, 95% CI 4.2–5.4), with IRRs ranging from 1.8 (95% CI 1.6, 2.1) for respiratory disease to 56.2 for avascular necrosis (95% CI 29.4, 107.5). In patients with ALL and AML, the highest IRRs were, respectively, for VTE (36.8, 16.4), renal disease (15.4, 14.1), diabetes (8.3, 6.1), and cardiovascular disease (6.3, 6.5). In patients with NHL and HL, the highest IRRs were, respectively, for avascular necrosis (34.2, 7.4), VTE (8.1, 7.0), renal (4.8, 5.8), and cardiovascular disease (2.9, 3.1). In AYAs with lymphomas, risk of most conditions was higher for those diagnosed with regional or distant disease (vs. localized). Elevated IRRs were observed across all demographic groups, insurance types, and neighborhood deprivation levels.

AYA survivors of hematologic malignancies had a higher risk of all chronic conditions than the non-cancer comparison cohort. Long-term surveillance, risk mitigation through lifestyle changes, and effective disease management should be evaluated to improve quality of life and reduce premature mortality.