期刊
JOURNAL OF CLINICAL ONCOLOGY
卷 31, 期 19, 页码 2469-+出版社
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2012.47.0500
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资金
- Associazione Italiana per la Ricerca sul Cancro [IG 5017]
- St Anna Kinderkrebsforschung
- Deutsche Krebshilfe
- Fordergemeinschaft Kinderkrebszentrum Hamburg
- Children's Oncology Group [CA098543, U10 CA98413]
- National Cancer Institute [5 P01CA068484]
- European Organisation for Research and Treatment of Cancer Charitable Trust
- Schroder Foundation
- Direction Recherche Clinique-Assistance Publique-Hopitaux de Paris
- Centre de Recherche en Oncologie, Hematologie et Pediatrie Association
- Israel Cancer Association
- Hayim Association for Children with Cancer in Israel
- Ministry of Health, Labour and Welfare of Japan
- Children's Cancer Association of Japan
- Danish Cancer Society [R40-A2154]
- Danish Childhood Cancer Foundation
- Swedish Childhood Cancer Foundation
- National Institutes of Health [CA-21765]
- American Lebanese Syrian Associated Charities
- Childhood Cancer Foundation Taiwan
- Medical Research Council (UK)
Purpose Second malignant neoplasms (SMNs) after diagnosis of childhood acute lymphoblastic leukemia (ALL) are rare events. Patients and Methods We analyzed data on risk factors and outcomes of 642 children with SMNs occurring after treatment for ALL from 18 collaborative study groups between 1980 and 2007. Results Acute myeloid leukemia (AML; n = 186), myelodysplastic syndrome (MDS; n = 69), and nonmeningioma brain tumor (n = 116) were the most common types of SMNs and had the poorest outcome (5-year survival rate, 18.1% 2.9%, 31.1% +/- 6.2%, and 18.3% +/- 3.8%, respectively). Five-year survival estimates for AML were 11.2% +/- 2.9% for 125 patients diagnosed before 2000 and 34.1% +/- 6.3% for 61 patients diagnosed after 2000 (P < .001); 5-year survival estimates for MDS were 17.1% +/- 6.4% (n = 36) and 48.2% +/- 10.6% (n = 33; P = .005). Allogeneic stem-cell transplantation failed to improve outcome of secondary myeloid malignancies after adjusting for waiting time to transplantation. Five-year survival rates were above 90% for patients with meningioma, Hodgkin lymphoma, thyroid carcinoma, basal cell carcinoma, and parotid gland tumor, and 68.5% +/- 6.4% for those with non-Hodgkin lymphoma. Eighty-nine percent of patients with brain tumors had received cranial irradiation. Solid tumors were associated with cyclophosphamide exposure, and myeloid malignancy was associated with topoisomerase II inhibitors and starting doses of methotrexate of at least 25 mg/m(2) per week and mercaptopurine of at least 75 mg/m(2) per day. Myeloid malignancies with monosomy 7/5q- were associated with high hyperdiploid ALL karyotypes, whereas 11q23/MLL-rearranged AML or MDS was associated with ALL harboring translocations of t(9;22), t(4;11), t(1;19), and t(12;21) (P = .03). Conclusion SMNs, except for brain tumors, AML, and MDS, have outcomes similar to their primary counterparts.
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