title: Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study.
abstract: Second primary malignancies and premature death are a concern for patients surviving treatment for childhood lymphomas. We assessed mortality and second malignant neoplasms (SMNs) among 1082 5-year survivors of non-Hodgkin lymphoma (NHL) in the Childhood Cancer Survivor Study, a multi-institutional North American retrospective cohort study of cancer survivors diagnosed from 1970 to 1986. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated using US population rates. Relative risks for death and solid tumor SMNs were calculated based on demographic, clinical, and treatment characteristics using Poisson regression models. There were 87 observed deaths (SMR = 4.2; 95% CI, 1.8-4.1) with elevated rates of death from solid tumors, leukemia, cardiac disease, and pneumonia. Risk for death remained elevated beyond 20 years after NHL. Risk factors for death from causes other than NHL included female sex (rate ratio [RR] = 3.4) and cardiac radiation therapy exposure (RR = 1.9). There were 27 solid tumor SMNs (SIR = 3.9; 95% CI, 2.6-5.7) with 3% cumulative incidence between 5 and 20 years after NHL diagnosis. Risk factors were female sex (RR = 3.1), mediastinal NHL disease (RR = 5.2), and breast irradiation (RR = 4.3). Survivors of childhood NHL, particularly those treated with chest RT, are at continued increased risk of early mortality and solid tumor SMNs.
authors.affiliation: Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, MSC 7238, Rockville, MD 20892-7238, USA. bluhme@mail.nih.gov
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Bluhm
authors.forename: Cécile
authors.initials: C
authors.lastname: Ronckers
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hayashi
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Mitby
authors.forename: John A
authors.initials: JA
authors.lastname: Whitton
authors.forename: Sue
authors.initials: S
authors.lastname: Hammond
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Barker
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Peter D
authors.initials: PD
authors.lastname: Inskip
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000628:therapy; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis