Second malignancies after autologous hematopoietic cell transplantation in children

K. E. Danner-Koptik, N. S. Majhail*, R. Brazauskas, Z. Wang, D. Buchbinder, J. Y. Cahn, K. J. Dilley, H. A. Frangoul, T. G. Gross, G. A. Hale, R. J. Hayashi, N. Hijiya, R. T. Kamble, H. M. Lazarus, D. I. Marks, V. Reddy, B. N. Savani, A. B. Warwick, J. R. Wingard, W. A. WoodM. L. Sorror, D. A. Jacobsohn

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Childhood autologous hematopoietic cell transplant (auto-HCT) survivors can be at risk for secondary malignant neoplasms (SMNs). We assembled a cohort of 1487 pediatric auto-HCT recipients to investigate the incidence and risk factors for SMNs. Primary diagnoses included neuroblastoma (39%), lymphoma (26%), sarcoma (18%), central nervous system tumors (14%) and Wilms tumor (2%). Median follow-up was 8 years (range, <1-21 years). SMNs were reported in 35 patients (AML/myelodysplastic syndrome (MDS)=13, solid cancers=20, subtype missing=2). The overall cumulative incidence of SMNs at 10 years from auto-HCT was 2.60% (AML/MDS=1.06%, solid tumors=1.30%). We found no association between SMNs risk and age, gender, diagnosis, disease status, time since diagnosis or use of TBI or etoposide as part of conditioning. OS at 5-years from diagnosis of SMNs was 33% (95% confidence interval (CI), 16-52%). When compared with age-And gender-matched general population, auto-HCT recipients had 24 times higher risks of developing SMNs (95% CI, 16.0-33.0). Notable SMN sites included bone (N=5 SMNs, observed (O)/expected (E)=81), thyroid (N=5, O/E=53), breast (N=2, O/E=93), soft tissue (N=2, O/E=34), AML (N=6, O/E=266) and MDS (N=7, O/E=6603). Risks of SMNs increased with longer follow-up from auto-HCT. Pediatric auto-HCT recipients are at considerably increased risk for SMNs and need life-long surveillance for SMNs.

Original languageEnglish (US)
Pages (from-to)363-368
Number of pages6
JournalBone Marrow Transplantation
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • autologous
  • hematopoietic cell transplantation
  • pediatric
  • risk factors
  • second cancers

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Danner-Koptik, K. E., Majhail, N. S., Brazauskas, R., Wang, Z., Buchbinder, D., Cahn, J. Y., Dilley, K. J., Frangoul, H. A., Gross, T. G., Hale, G. A., Hayashi, R. J., Hijiya, N., Kamble, R. T., Lazarus, H. M., Marks, D. I., Reddy, V., Savani, B. N., Warwick, A. B., Wingard, J. R., ... Jacobsohn, D. A. (2013). Second malignancies after autologous hematopoietic cell transplantation in children. Bone Marrow Transplantation, 48(3), 363-368. https://doi.org/10.1038/bmt.2012.166