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Ferrata Storti Foundation
Haematologica 2021 Volume 106(5):1390-1400
Non-Hodgkin Lymphoma
Second malignancies after treatment of childhood non-Hodgkin lymphoma – a report of the Berlin-Frankfurt-Muenster study group
Olga Moser,1 Martin Zimmermann,2 Ulrike Meyer,3 Wolfram Klapper,4
Ilske Oschlies,4 Martin Schrappe,5 Andishe Attarbaschi,6 Georg Mann,6 Felix Niggli,7 Claudia Spix,8 Udo Kontny,1 Thomas Klingebiel,9 Alfred Reiter,3 Birgit Burkhardt10 and Wilhelm Woessmann11
1Division of Pediatric Hematology and Oncology, RWTH-Aachen University, Aachen, Germany; 2Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany; 3Department of Pediatric Hematology and Oncology, Justus Liebig- University Giessen, Giessen, Germany; 4Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany; 5Department of Pediatric Hematology and Oncology, Children’s University Hospital, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany; 6Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria; 7Department of Pediatric Hematology and Oncology, Children’s University Hospital Zurich, Zurich, Switzerland; 8German Childhood Cancer Registry (GCCR) at Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI) of the Mainz University Medical Center, Mainz, Germany; 9Department of Pediatric Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany; 10Pediatric Hematology and Oncology, University Hospital Muenster, Muenster, Germany and 11Department of Pediatric Hematology and Oncology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
ABSTRACT
Second malignant neoplasms (SMN) pose a concern for survivors of childhood cancer. We evaluated incidence, type and risk factors for SMN in patients included in Berlin-Frankfurt-Muenster protocols for childhood non-Hodgkin lymphoma.3,590 patients <15 years of age at diag- nosis, registered between 01/1981 and 06/2010, were analyzed. SMN were reported by the treating institutions and the German Childhood Cancer Registry. After a median follow-up of 9.4 years (quartile [Q] range, Q1 6.7 and Q3 12.1) 95 SMN were registered (26 carcinomas including nine basal cell carcinomas, 21 acute myeloid leukemias/myelodysplastic syndromes, 20 lymphoid malignancies, 12 central nervous system [CNS]-tumors, and 16 others). Cumulative incidence at 20 years was 5.7±0.7%, standard inci- dence ratio, excluding basal cell carcinomas, was 19.8 (95% Confidence Interval [CI]: 14.5-26.5). Median time from initial diagnosis to second malignancy was 8.7 years (range, 0.2-30.3 years). Acute-lymphoblastic- leukemia-type therapy, cumulative anthracycline dose, and cranial radio- therapy for brain tumor-development were significant risk factors in uni- variate analysis only. In multivariate analysis including risk factors signifi- cant in univariate analysis, female sex (hazard ratio [HR] 1.87, 95% CI: 1.23-2.86, P=0.004), CNS-involvement (HR 2.24, 95% CI: 1.03-4.88, P=0.042), lymphoblastic lymphoma (HR 2.60, 95% CI: 1.69-3.97, P<0.001), and cancer-predisposing condition (HR 11.2, 95% CI: 5.52-22.75, P<0.001) retained an independent risk. Carcinomas were the most frequent SMN after non-Hodgkin lymphoma in childhood followed by acute myeloid leukemia and lymphoid malignancies. Female sex, lymphoblastic lym- phoma, CNS-involvement, or/and known cancer-predisposing condition were risk factors for SMN-development. Our findings set the basis for indi- vidualized long-term follow-up and risk assessment of new therapies.
Correspondence:
OLGA MOSER
omoser@ukaachen.de
Received: December 11, 2019. Accepted: April 9, 2020. Pre-published: April 16, 2020.
https://doi.org/10.3324/haematol.2019.244780
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