Sørensen GV, Belmonte F, Erdmann F, et al. - In this population-based Nordic cohort, a higher late mortality in survivors of acute lymphoblastic leukemia (ALL) was observed in comparison to population comparison individuals. Survivors showed a temporal decrease in risk of death from relapse, without increases in health-related death.

• A total of 3,765 five-year survivors of ALL were identified and for each survivor, up to five matched comparison persons were randomly selected from the general population (n = 18,323).

• In survivors, 315 deaths happened during a median follow-up of 16 years from 5-year survival date (range 0–42); most were due to relapse, followed by second neoplasm.

• Over treatment decades, a slow decline in cumulative incidence of all-cause late mortality at 15 years from diagnosis was observed; from 14.4% for survivors diagnosed during 1971–1981, to 2.5% for those diagnosed during 2002–2008.

• This was primarily because of a decrease in relapse-related deaths declining from 13.4% for survivors diagnosed during 1971–1981 to 1.9% for those diagnosed during 2002–2008.

• Health-related late mortality was low and was not altered substantially across treatment decades.

• Relative to the comparison group, all-cause death hazard ratios were estimated to be 40 (95% CI: 26–61) 5–9 years from diagnosis, and 4.4 (95% CI: 3.4–5.6) ≥10 years from diagnosis.