Abstract
Incidence of secondary malignancies in Polish children treated for acute lymphoblastic leukemia according to the ALL-IC BFM 2002 protocol
- Department of Genetic Predisposition to Cancer, Medical University of Lodz, Poland
- Department of Genetic Predisposition to Cancer, Department of Pediatrics, Oncology and Hematology, Central Clinical Hospital, Lodz, Poland
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
- Department of Pediatrics, Hematology and Oncology, Medical University of Zabrze, Zabrze, Poland
- Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
- Department of Pediatric Oncology and Hematology, Children’s University Hospital, Jagiellonian University, Krakow, Poland
- Department of Pediatric Transplantology, Oncology, Hematology, Medical University of Wroclaw, Wroclaw, Poland
- Department of Pediatric Oncology, Hematology and Transplantology, Medical University of Poznan, Poznan, Poland
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum of Bydgoszcz, Bydgoszcz, Poland
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
- Department of Pediatrics, Hemato-Oncology and Pediatric Gastroenterology, Medical University of Szczecin, Szczecin, Poland
- Department of Pediatrics, Medical University of Katowice, Katowice, Poland
- Department of Pediatric Oncology and Hematology, Children’s Hospital, Kielce, Poland
- Department of Pediatric Oncology, Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, Warsaw, Poland
- Department of Pediatrics, Oncology and Hematology, Central Clinical Hospital, Lodz, Poland
Introduction:
Acute lymphoblastic leukemia (ALL) is the most commonly diagnosed childhood cancer, with a peak incidence around 5 years of age. Aim of the study was to assess the incidence, type, and outcome of secondary malignancies in children who were primarily treated for ALL.
Material and methods:
We enrolled in the analysis 1868 children uniformly treated for ALL between 2 October 2002 and 22 December 2012 according to the protocol ALL-IC BFM 2002. In this study group, we assessed the incidence and type of secondary cancer and outcome.
Results:
We identified 12 patients (0.64%) who developed secondary malignancies after the median time of 1.72 years from the primary diagnosis of ALL (range: 11.5 months to 18 years). The most frequently diagnosed second neoplasms were hematological malignancies (8 out of 12; 66.7%) including acute myeloid leukemia (AML) (n = 4), non-Hodgkin lymphoma (NHL) (n = 2), chronic myeloid leukemia (CML) (n = 1), and leukemia of unknown immunophenotype (n = 1). In total, four children developed subsequent solid tumors: Ewing sarcoma (n = 1), primitive neuroectodermal tumor (n = 1), myeloid sarcoma (n = 1), and solid tumors of unknown origin (n = 1). Children diagnosed with second cancer were non-significantly older at primary ALL diagnosis in comparison with patients without second cancer (12.083 [3.4–14.0] vs. 5.25 [3.2–10.2]; p = 0.063). The risk group distribution differed between patients with and without a second cancer: 2 (16.67%) vs. 606 (32.65%) children were assigned to the standard risk (SR) group, 5 (41.67%) vs. 894 (48.17%) in the intermediate risk (IR) group, and 5 (41.67%) vs. 356 (19.18%) in the high risk (HR) group. Patients with secondary malignancies showed a significantly lower probability of 5-year overall survival as compared to children without subsequent tumors: 26.5% vs. 85.7%; p < 10–5; HR = 5.9; 95% CI: 2.91–11.96.
Conclusions:
Blood cancers are the most frequently observed malignancies in children treated for ALL during the first 3 years after treatment completion. Diagnosis of secondary tumor after being treated for ALL is related to poor outcome.
Keywords
pediatric acute lymphoblastic leukemia, secondary neoplasm, ALL-IC BFM 2002
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