Development of Secondary Osteosarcoma After TBI and Allogeneic Bone Marrow Transplant: A Case Series of 3 Patients

Abstract

Osteosarcoma can rarely occur as a subsequent malignant neoplasm after cancer therapy. Children who underwent treatment for cancer and received an allogeneic hematopoietic cell transplant are at a higher risk to develop secondary malignancies. Radiation is also a known risk factor, but estimating the quantitative risk is difficult due to the rarity of the condition and long latency period between primary and secondary cancer. In this report, we present 3 patients diagnosed with leukemia as young children who received hematopoietic cell transplants with total body irradiation as part of the conditioning regimen, and later went on to develop secondary osteosarcoma.

Secondary Osteosarcoma After Bone Marrow Transplant: An Aggressive Disease

“…23 Second tumors are an important complication of BMT, but secondary osteosarcoma has rarely been reported in this setting. [4][5][6][7][8][9][10][11][12][13][14] The few reports on the outcome of osteosarcoma after ALL and/or BMT suggest that this is an aggressive tumor with a poor prognosis. We found 21 cases of osteosarcoma secondary to allogeneic BMT in the literature.…”

“…We found 21 cases of osteosarcoma secondary to allogeneic BMT in the literature. [4][5][6][7][8][9][10][11][12][13][14] The median age at diagnosis was 15 years (range 7-26 years). The reason for BMT was ALL in 13 patients, whereas the others were single cases of acute myeloid leukemia, neuroblastoma, chronic granulomatous disease, Blackfan-Diamond anemia, congenital amegakaryocytic thrombocytopenia, myelodysplastic syndrome, and non-Hodgkin lymphoma.…”

“…3 Osteosarcoma after bone marrow transplant (BMT) is also very rare, but tends to be locally invasive, and often metastatic; and the reported prognosis is poor. [4][5][6][7][8][9][10][11][12][13][14] This report describes three children with ALL who underwent BMT and subsequently developed secondary osteosarcoma. The treatment options are discussed.…”

Survival analysis and prognostic model establishment of secondary osteosarcoma: a SEER-based study

“…The worst prognosis of SO mainly stems from its typical characteristics, which consist of local invasion, high-grade and distant metastasis, as well as not-in-time treatment and the intolerance of patients 8 . In addition, the prior malignancy history may make it more complicated to conform diagnosis and accurate fight against osteosarcoma cells 9 – 12 . To conclude, SO could pose a great challenge to long-term survival.…”

“…To our knowledge, there is few research on the surgery compliance of SO. Only a few case studies have been done in previous literature 9 – 11 . Other studies with slightly larger samples focused on the overall assessment and did not specifically reveal determinants of surgical compliance 13 , 14 .…”