title: Second malignancy after treatment of childhood non-Hodgkin lymphoma.
abstract: BACKGROUND
  The objective of this report was to determine the cumulative incidence of and risk factors for second malignancy and the competing risk of death due to any other cause among patients who were treated for childhood non-Hodgkin lymphoma (NHL).
  
  
  METHODS
  The authors retrospectively reviewed a cohort of 497 patients with NHL who were treated at St. Jude Children's Research Hospital between 1970 and 1997.
  
  
  RESULTS
  A second malignancy developed in 16 patients (9 patients with solid tumors and 7 patients with secondary acute myeloid leukemia [AML]). This number was 10.8-fold (95% confidence interval, 6.1-16.9) higher than the 1.48 patients projected for the general population by SEER Cancer Statistics. The estimated cumulative incidence rate of second malignancy was 2.1% +/- 0.7% at 10 years after diagnosis of NHL and increased to 4.8% +/- 1.3% at 20 years after diagnosis. The cumulative incidence rate of second malignancy was least among patients with small noncleaved cell lymphoma (0.5% +/- 0.5% at 20 years), higher among patients with large cell lymphoma (5.8% +/- 3.3% at 20 years), and highest among patients with lymphoblastic lymphoma (10.9% +/- 3.6% at 20 years; P = 0.002 for overall comparison). Exposure to epipodophyllotoxins was a risk factor for the development of secondary AML (P < 0.001). The cumulative incidence rate of death due to other causes was significantly less for patients who were treated after June 1978 (19.9% +/- 2.2% at 10 years) compared with patients who were treated earlier (55.6% +/- 4.2% at 10 years; P < 0.001), whereas the risk of second malignancy was similar for these two eras.
  
  
  CONCLUSIONS
  Survivors of childhood NHL, especially those with lymphoblastic histology, are at a greater risk of developing a second malignancy compared with the general population. The incidence rate of second malignancy has remained unchanged despite a recent decline in the risk of death related to primary NHL or earlier treatment complications.
authors.affiliation: St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105-2794, USA. wing.leung@stjude.org
authors.forename: W
authors.initials: W
authors.lastname: Leung
authors.forename: J T
authors.initials: JT
authors.lastname: Sandlund
authors.forename: M M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Y
authors.initials: Y
authors.lastname: Zhou
authors.forename: M L
authors.initials: ML
authors.lastname: Hancock
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
authors.forename: R C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: J E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
authors.forename: B
authors.initials: B
authors.lastname: Razzouk
authors.forename: W E
authors.initials: WE
authors.lastname: Evans
authors.forename: C H
authors.initials: CH
authors.lastname: Pui
mesh_terms: D000293:Adolescent; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D011034:Podophyllotoxin / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D011034:Podophyllotoxin