Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983
Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983
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DOI：
10.1182/blood.v99.12.4257
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发表时间：
2002-06-15
期刊：
影响因子：
20.3
通讯作者：
Robison, LL
中科院分区：
文献类型：
--
作者：
Bhatia, S;Sather, HN;Robison, LL
第二，恶性肿瘤是儿童急性淋巴细胞白血病（ALL）治疗成功后的严重并发症。随着生存率的提高，评估当代基于风险的治疗方法对ALL幸存者第二肿瘤的影响是很重要的。在1983年至1995年期间，882111名被诊断为ALL的儿童参加了儿童癌症组的治疗方案，观察了第二肿瘤的发生率和相关危险因素。ALL诊断时的中位年龄为4.7岁。该队列累积了54 883人年的随访。63例患者发生第二肿瘤，包括实体非造血肿瘤（39例，脑肿瘤19例，其他实体肿瘤20例）、髓性白血病或骨髓异常增生（16例）、淋巴瘤（8例）。任何第二肿瘤的累积发病率在10年为1.18%(95%可信区间，0.8%-1.5%)，与普通人群相比，风险增加了7.2倍。急性髓系白血病（标准化发病率[SIR] 52.3）、非霍奇金淋巴瘤（SIR 8.3）、腮腺肿瘤（SIR 33.4）、甲状腺癌（SIR 13.3）、脑肿瘤（SIR 10.1）和软组织肉瘤（SIR 9.1）的风险显著增加。多因素分析显示，女性（相对危险度[RR] 1.8）、颅脊柱轴放射（FIR 1.6）和原发疾病复发（FIR 3.5）与所有第二肿瘤的风险增加独立相关。第二肿瘤的发生风险随放射剂量的增加而增加（11800 cGy RR为1.5；2400 cGy FIR为3.9）。诊断第二肿瘤后10年的精算生存率为39%。对接受当代基于风险的治疗的这一大型队列的随访显示，在诊断为儿童ALL后，第二肿瘤的发生率仍然很低。[医学杂志];2002;99:4257-4264]。(C) 2002年由美国血液病学会出版。
Second malignant neoplasms are a serious complication after successful treatment of childhood acute lymphoblastic leukemia (ALL). With improvement in survival, it is important to assess the impact of contemporary risk-based therapies on second neoplasms in ALL survivors. A cohort of 882111 children diagnosed with ALL and enrolled on Children's Cancer Group therapeutic protocols between 1983 and 1995 were observed to determine the incidence of second neoplasms and associated risk factors. The median age at diagnosis of ALL was 4.7 years. The cohort had accrued 54 883 person-years of follow-up. Sixty-three patients developed second neoplasms, including solid, nonhematopoietic tumors (n = 39: brain tumors n = 19, other solid tumors n = 20), myeloid leukemia or myelodysplasia (n = 16), and lymphoma (n = 8). The cumulative incidence of any second neoplasm was 1.18% at 10 years (95% confidence interval, 0.8%-1.5%), representing a 7.2-fold increased risk compared with the general population. The risk was increased significantly for acute myeloid leukemia (standardized incidence ratio [SIR] 52.3), non-Hodgkin lymphoma (SIR 8.3), parotid gland tumors (SIR 33.4), thyroid cancer (SIR 13.3), brain tumors (SIR 10.1), and soft tissue sarcoma (SIR 9.1). Multivariate analysis revealed female sex (relative risk [RR] 1.8), radiation to the craniospinal axis (FIR 1.6), and relapse of primary disease (FIR 3.5) to be independently associated with increased risk of all second neoplasms. Risk of second neoplasms increased with radiation dose (11800 cGy RR 1.5; 2400 cGy FIR 3.9). Actuarial survival at 10 years from diagnosis of second neoplasms was 39%. Follow-up of this large cohort that was treated with contemporary risk-based therapy showed that the incidence of second neoplasms remains low after diagnosis of childhood ALL. (Blood. 2002;99: 4257-4264). (C) 2002 by The American Society of Hematology.