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Second malignancy after childhood NHL
8.1 years (range, 0.3-14.9 years) for patients who subse- quently developed a SMN. The median time from first diagnosis of NHL to SMN was 8.7 years (range, 0.2-30.3 years). The median time to development of all carcinomas was 15.9 years (range, 0.7-30.3 years), and 11.6 years (range, 0.7-23.7 years) excluding basal-cell carcinomas. The median time was 3.1 years (range, 0.3-8.7 years) for AML/MDS, 5.7 years (range, 1.5-20.2 years) for second lymphoid malignancy, and 8.6 years (range, 0.8-17.3
years) for CNS-tumors, respectively (Table 3). Carcinomas of the gastrointestinal tract and basal-cell carcinoma were the most frequent carcinomas (nine cases each) (Table 3). Six of the nine gastrointestinal tract-carcinomas occurred after a T-cell LBL.
Univariate analysis of risk factors (Table 1)
Cumulative incidence of SMN was significantly higher among patients with LBL (9.3% at 20 years, SE=1.9%)
Table 3. Characteristics and outcome of patients with second malignant neoplasms after non-Hodgkin lymphoma in children.
Second malignant neoplasm
Primary NHL
Stage
of disease I/II/III/IV
1/0/8/12
2/3/13/2
0/3/6/3
3/1/18/4
0/2/1/2
0/1/2/1
0/1/5/1
No. Sex of pts M/F
21 12/9
20 13/7
12 9/3
26 13/13
5 4/1
4 2/2
7 2/5
SMN type [no. of patients]
MDS and AML
MDS-AML del(5),del(7) and/or complex karyotype [6] AML t(11q23) [4]
AML normal karyotype [5] AML other [3]
AML no cytogenetics [3]
Second lymphoid malignancy
T-LBL [3] ALL [4] BL/B-AL [3] B-NHL [3] ALCL [1] PTCL [2] HD [4]
CNS malignant tumors
Glioblastoma multiforme [3] Anapl. Astrocytoma °III [3] Anapl. Meningeoma°III [3] Medulloblastoma [1] undifferentiated [2]
Carcinoma
Basal cell carcinoma [9] Gastrointestinal tract [9] Thyroid [4] Breast [1]
NPC [1]
Renal [1] Urothel [1]
Sarcoma
RMA [1] Leiomyosarcoma [1] Clear cell sarcoma [1] Ewing sarcoma [1] Osteosarcoma [1]
Malignant Melanoma
Other
Extrarenal rhabdoid tumor [1] Seminoma [1] Malignant Phylloides [1] Desmoid-Fibromatosis [1] Hemangioendothelioma [1] LCH [1] Polycythemia rubra vera [1]
Latency years median (range)
3.1 (0.3 – 8.7)
5.7
(1.5 – 20.2)
8.6 (0.8 - 17.3)
15.9
(0.7 – 30.3)
8.6 (1.9-15.3)
12.3
(1.6-30.0)
6.3 (0.2-14.7)
Outcome: alive/death/3rd malignancy/LFU
5/14/1/2
7/7/5/2
3/6/1/3
15/4/1/6
3/2/0/0
3/0/0/1
2/3/1/2
Type of NHL [no. of patients]
T-LBL [9] pB-LBL [5] BL/B-AL [5] B-NHL [1] NHL nfc [1]
T-LBL [3]
BL/B-AL [4] B-NHL [10] ALCL [3]
T-LBL [4] pB-LBL [1] BL/B-AL [2] B-NHL [3] ALCL [1] PTCL [1]
T-LBL [13]
pB-LBL [1] BL/B-AL [4] B-NHL [1] ALCL [6] NHL n.f.c. [1]
T-LBL [1] BL/B-AL [2] B-NHL [1] NHL nfc[1]
T-LBL [1]
BL [1]
B-NHL [2]
T-LBL [3] B-NHL [1] ALCL [3]
Age
at Dx years median (range)
3.4 (0.7-14.6)
8.1
(0.7-14.9)
6.8 (1.9-11.3)
9.5
(1.6-13.3)
5.5 (1.3-10.4)
10.5
(5.3-13.7)
10.1 (0.3-13.5)
Therapy Radio-therapy type Yes/no/ ALL/B-NHL unknown
15/6 4/15/2
3/17 1/19/0
6/6 7/2/3
15/11 8/14/4
1/4 1/4/0
1/3 1/3/0
2/5 0/7/0
ALCL: anaplastic large-cell lymphoma; B-NHL: mature B-cell lymphoma (other than BL/B-AL); BL/B-AL: Burkitt lymphoma /leukemia; HD: Hodgkin disease; LCH: Langenhans cell histiocytosis; LBL: lymphoblastic lymphoma; nfc: not further classified; NPC: nasopharyngeal carcinoma; PTCL: peripheral T-cell lymphoma; RMA: alveolary rhabdomyosar- coma. pts: points; no.: number; Dx: diagnosis.
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