Secondary neoplasms subsequent to Berlin-Frankfurt-Munster therapy of acute lymphoblastic leukemia in childhood:: significantly lower risk without cranial radiotherapy
Secondary neoplasms subsequent to Berlin-Frankfurt-Munster therapy of acute lymphoblastic leukemia in childhood:: significantly lower risk without cranial radiotherapy
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DOI：
10.1182/blood.v95.9.2770.009k16_2770_2775
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发表时间：
2000-05-01
期刊：
影响因子：
20.3
通讯作者：
Schrappe, M
中科院分区：
文献类型：
--
作者：
Löning, L;Zimmermann, M;Schrappe, M
继发性肿瘤（SN）是恶性疾病成功治疗后的严重晚期并发症。为了评估柏林-法兰克福-明斯特（BFM）治疗儿童急性淋巴细胞白血病（ALL）后SN的发生率和类型，我们分析了1979年4月至1995年4月期间BFM数据库和德国儿童癌症登记处（GCCR）的数据。5个ALL-RPM多中心临床试验共纳入5006例B前体细胞或T-ALL患儿，中位随访时间为5.7年（范围1.5-18年）。截至1997年12月，共记录了52例SN，包括16例急性髓性白血病（AML）、13例中枢神经系统（CNS）肿瘤和23例其他肿瘤。与根据GCCR得出的发病率估计的预期数字相比，这代表所有癌症增加了14倍，CNS肿瘤增加了19倍，SN发展为0.9至15年（中位数：6年）确诊ALL后; 46例患者首次完全缓解（CR），15年时SN的总累积风险为3.3%（95%置信区间[CI]：1.6%-4.2%）和2.9%（95% CI：1.6%-4.2%）。治疗后，包括头部照射，风险为3.5%（95% CI：1.5%-5.5%），未接受照射的患者风险显著降低：1.2%（95% CI：0.2%-2.3%; P= 0.048）。继发性AML的发生与任何特定细胞毒性药物的使用无关，考虑到该大型AML队列的高生存率，SN的风险相对较低，但高于一般人群，尤其是在颅照射后。长期随访是强制性的，预计会有更多潜伏期更长的SN。（血。2000;95：2770-2775）（C）2000由美国血液学学会。
Secondary neoplasms (SNs) represent serious late complications after successful treatment of malignant diseases, To evaluate the rate and type of SNs after Berlin-Frankfurt-Munster (BFM) treatment in children with acute lymphoblastic leukemia (ALL), we analyzed the data from the BFM database and the German Childhood Cancer Registry (GCCR), Between April 1979 and April 1995, 5006 children with B-precursor or T-ALL were enrolled in 5 ALL-RPM multicenter trials, The median follow-up time from diagnosis was 5.7 years (range 1.5-18 years). By December 1997, 52 SNs were documented, including 16 acute myeloid leukemias (AMLs), 13 neoplasms of the central nervous system (CNS), and 23 other neoplasms. Compared with the expected numbers estimated from incidence rates derived from the GCCR, this represented a 14-fold increase for all cancers and a 19-fold increase for CNS tumors, SNs developed 0.9 to 15 years (median: 6 years) after the diagnosis of ALL; 46 patients were in first complete remission (CR), The overall cumulative risk of SNs at 15 years was 3.3% (95% confidence interval [CI]: 1.6%-4.2%) and 2.9% (95% CI: 1.6%-4.2%) in first CR. The risk was 3.5% (95% CI: 1.5%-5.5%) after treatment, including cranial irradiation and significantly lower in nonirradiated patients: 1.2% (95% CI: 0.2%-2.3%; P=.048). The development of secondary AML was not associated with the use of any specific cytotoxic agent, Considering the high-survival rate of this large unselected ALL cohort, the risk of SN is relatively low, though higher, especially after cranial irradiation, than in the general population. Long-term follow-up is mandatory, and further SNs with longer latency periods are to be expected. (Blood. 2000;95:2770-2775) (C) 2000 by The American Society of Hematology.