Second malignancies after autologous hematopoietic cell transplantation in children

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.; Wood, W. A.; Sorror, M. L.; Jacobsohn, D. A.

Bone Marrow Transplant. 2012 Sep 12; 48(3):363-8

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.

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