Characteristics and Outcomes of Second Malignant Neoplasms after Childhood Cancer Treatment: Multi-Center Retrospective Survey

Abstract

This retrospective study investigated the clinical characteristics and outcomes of second malignant neoplasms (SMNs) in survivors of childhood cancer from multiple institutions in Korea. A total of 102 patients from 11 institutions who developed SMN after childhood cancer treatment between 1998 and 2011 were retrospectively enrolled. The most common primary malignant neoplasms (PMNs) were central nervous system (CNS) tumors (n = 17), followed by acute lymphoblastic leukemia (n = 16), non-Hodgkin lymphoma (n = 13), and osteosarcoma (n = 12). The most common SMNs were therapy-related myeloid neoplasms (t-MNs; acute myeloid leukemia [AML], 29 cases; myelodysplastic syndrome [MDS], 12 cases), followed by thyroid carcinomas (n = 15) and CNS tumors (n = 10). The median latency period was 4.9 years (range, 0.5–18.5 years). Among 45 patients with solid tumors defined as an SMN, 15 (33%) developed the lesion in a field previously subjected to radiation. The 5-year overall survival (OS) rate of patients with an SMN was 45% with a median follow-up time of 8.6 years. Patients with AML, MDS, and CNS tumors exhibited the poorest outcomes with 5-year OS rates of 18%, 33%, and 32%, respectively, whereas those with second osteosarcoma showed comparable outcomes (64%) to patients with primary counterpart and those with second thyroid carcinoma had a 100% OS rate. Further therapeutic efforts are recommended to improve the survival outcomes in patients with SMNs, especially in cases with t-MNs and CNS tumors.

Therapy‐related acute myeloid leukemia following treatment for cancer in childhood: A population‐based registry study

“…20 We were also able to verify a striking 5-year survival benefit when HSCT was used to treat t-AML. Our results are consistent with studies elsewhere 6,12,[16][17][18] that have demonstrated the therapeutic benefits of HSCT for pediatric patients with t-AML. These collective findings indicate that therapy for t-AML in children should be with the aim of achieving remission and bridging patients to HSCT.…”

“…8 Half of the patients with childhood cancer developed t-AML between 2 and 5 years after the first diagnosis, which is also in keeping with prior adult studies that found a median latency period of 4-5 years. 15 A few studies conducted using surveys of hospital-based series of pediatric patients have reported outcomes for t-AML, 6,12,[16][17][18][19] but some of the findings are difficult to interpret as t-AML tends to be mixed in with other therapy-related cancers. Further, each of these studies involved a very small number of patients with t-AML (range of 16-36).…”

Impact of latency time on survival for adolescents and young adults with a second primary malignancy

“…A few studies of older adult populations of either prostate or renal cell carcinoma survivors compared survival for patients who did and did not develop an SPM. [35][36][37][38] None demonstrated a difference in CSS in this older cohort, but they did show a detrimental impact on overall survival. Again, neither latency nor adjustments for age, race/ethnicity, or the stages of both cancers were detailed.…”

“…All showed an increased risk of death if a tumor occurred as an SPM versus a primary cancer, although few evaluated whether death was due to the PM or SPM. A few studies of older adult populations of either prostate or renal cell carcinoma survivors compared survival for patients who did and did not develop an SPM . None demonstrated a difference in CSS in this older cohort, but they did show a detrimental impact on overall survival.…”

Therapy-related Acute Myeloid Leukemia After the Treatment of Primary Solid Cancer in Children: A Single-center Experience

“…[1][2][3][4] Among them, therapy-related acute myeloid leukemia (t-AML) has the shortest median latency time and a dismal outcome. 5,6 For this reason, pediatric oncologists are likely to encounter t-AML or therapy-related myelodysplastic syndrome (t-MDS) more often as an SMN compared with other secondary tumors.…”