Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia
Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia
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DOI：
10.1001/jama.297.11.1207
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发表时间：
2007-03-21
影响因子：
120.7
通讯作者：
Pui, Ching-Hon
中科院分区：
文献类型：
--
作者：
Hijiya, Nobuko;Hudson, Melissa M.;Pui, Ching-Hon
背景：对儿童和青少年急性淋巴细胞白血病治疗15 ~ 20年后继发性肿瘤的发病率知之甚少。目的：研究儿童急性淋巴细胞白血病治疗30年后继发性肿瘤的累积发病率，并描述迟发性肿瘤的特征。对1962年至1998年在田纳西州孟菲斯圣裘德儿童研究医院接受治疗的2169例急性淋巴细胞白血病患者进行回顾性研究，这些患者达到完全缓解，中位随访时间为18.7年结果123例患者中，继发性肿瘤作为首次事件发生，包括46例骨髓恶性肿瘤，3例淋巴瘤，14例基底细胞癌，16例其他癌，6例肉瘤，16例脑膜瘤，22例其他脑瘤。15年时继发性肿瘤的累积发生率为4.17%（SE，0.46%），20年后显著增加，30年时达到10.85%（SE，1.27%）。当排除脑膜瘤和基底细胞癌时，15年时的总累积发病率为3.99%（SE，0.44%），30年时为6.27%（SE，0.83%），与普通人群相比，总风险增加了13.5倍。30年时各肿瘤类型的累积发病率为2.19%（SE，0.32%）髓系恶性肿瘤，0.17%（SE，0.10%）淋巴瘤，3.00%（SE，0.59%）脑肿瘤，4.91%结论急性淋巴细胞白血病治疗后30年内继发肿瘤的累积发生率呈上升趋势。虽然大多数迟发性继发性肿瘤是低级别肿瘤，但侵袭性更强的恶性肿瘤的发病率增加显著高于一般人群的预期。这些结果表明，需要对急性淋巴细胞白血病幸存者进行终身随访，以确定治疗和其他白血病相关因素对继发性肿瘤发展的全面影响。
Context Little is known about the incidence of secondary neoplasms after 15 to 20 years in children and adolescents who were treated for acute lymphoblastic leukemia.Objectives To investigate the cumulative incidence of secondary neoplasms in pediatric patients treated for acute lymphoblastic leukemia over 30 years and to characterize late-occurring tumors.Design, Setting, and Patients Retrospective study of 2169 patients with acute lymphoblastic leukemia treated between 1962 and 1998 at St Jude Children's Research Hospital, Memphis, Tenn, who achieved complete remission and had a median follow-up time of 18.7 years (range, 2.4-41.3 years).Main Outcome Measures Cumulative incidences of secondary neoplasms in first remission and standard incidence ratios of observed rates compared with rates of cancer development in the general US population.Results Secondary neoplasms developed as the first event in 123 patients and comprised 46 myeloid malignancies, 3 lymphomas, 14 basal cell carcinomas, 16 other carcinomas, 6 sarcomas, 16 meningiomas, and 22 other brain tumors. The cumulative incidence of secondary neoplasm was 4.17% (SE, 0.46%) at 15 years and increased substantially after 20 years, reaching 10.85% (SE, 1.27%) at 30 years. When meningiomas and basal cell carcinomas were excluded, the overall cumulative incidence was 3.99% (SE, 0.44%) at 15 years and 6.27% (SE, 0.83%) at 30 years, representing a 13.5-fold increase in overall risk compared with the general population. The cumulative incidence of each tumor type at 30 years was 2.19% (SE, 0.32%) for myeloid malignancy, 0.17% (SE, 0.10%) for lymphoma, 3.00% (SE, 0.59%) for brain tumor, 4.91% (SE, 1.04%) for carcinoma, and 0.57% (SE, 0.37%) for sarcoma.Conclusions The cumulative incidence of secondary neoplasms increases steadily over 30 years after treatment of acute lymphoblastic leukemia. Although the majority of the late-occurring secondary neoplasms are low-grade tumors, the increase in incidence of more aggressive malignant neoplasms is significantly higher than expected in the general population. These results suggest that lifelong follow-up of acute lymphoblastic leukemia survivors is needed to ascertain the full impact of treatment and other leukemia-related factors on secondary neoplasm development.