Second malignant neoplasms after treatment of 1487 children and adolescents with acute lymphoblastic leukemia—A population‐based analysis of the Austrian ALL‐BFM Study Group

Abstract

Second malignant neoplasms (SMN) after primary childhood acute lymphoblastic leukemia (ALL) are rare. Among 1487 ALL patients diagnosed between 1981 and 2010 in Austria, the 10-year cumulative incidence of an SMN was 1.1% ± 0.3%. There was no difference in the 10-year incidence of SMNs with regard to diagnostic-, responseand therapy-related ALL characteristics except for a significantly higher incidence in patients with leukocytes ≥50.0 G/L at ALL diagnosis (2.1% ± 1.0% vs. 0% for 20.0-50.0 G/L, and 1.0% ± 0.3% for < 20.0 G/L; p = 0.033). Notably, there was no significant difference in the incidence of SMNs between patients with or without cranial radiotherapy (1.2% ± 0.5% vs. 0.8% ± 0.3%; p = 0.295). Future strategies must decrease the incidence of SMNs, as this event still leads to death in one-third (7/19) of the patients.

Prognosis of Second Primary Malignancies in Pediatric Acute Lymphoblastic Leukemia Survivors: A Multicenter Study by the Turkish Pediatric Hematology Society

“…Moreover, the factors affecting the survival rate were found to be prednisolone response on day 8, bone marrow response on day 15, remission status on day 33, minimal residual disease, and the final risk group. 13 In our study, patients diagnosed after 5 years of age had significantly worse OS. There was no significant difference in the OS between sexes, patients who received and did not receive RT occurring relapse, received HSCT, and ALL chemotherapy protocols.…”

“…A study conducted by Schmiegelow et al 15 reported that from 2000 onwards, the 10-year probability of survival rate was 40.9% for patients diagnosed with an SPM after ALL. In another study by Poyer et al, 13 the 5-year OS was found to be 55% in patients with SPM. In the present study, the 5-year OS rate was 70% for patients diagnosed with an SPM after ALL.…”

“…11,12 An Austrian ALL-BFM Study Group reported that among 1487 patients with ALL diagnosed between 1981 and 2010, the 10-year cumulative incidence of an SPM was 1.1% ± 0.3%. 13 Risk factors for developing SPM after ALL have been reported to include young age, female sex, and cranial radiation. The most common SPMs in ALL survivors are brain tumors, thyroid cancers, other leukemia, or salivary gland tumors.…”

“…17,18 In addition, TBI is a significant cause of the development of SPMs and a range of other long-term side effects in children and later in adulthood. 17 Poyer et al 13 reported that 75% of patients who developed an SPM underwent CRT. In the present study, 81% of patients who had cranial irradiation, had cancer related to the irradiation field and 60% (3/5) of TBI recipients had cancer related to TBI-based conditioning.…”

“…The 15-year cumulative incidence of SPM in survivors of childhood ALL is 2.5% to 4% but rises to 6% when follow-up extends to 30 years 11,12 . An Austrian ALL-BFM Study Group reported that among 1487 patients with ALL diagnosed between 1981 and 2010, the 10-year cumulative incidence of an SPM was 1.1% ± 0.3% 13 …”