title: Second malignancies after autologous hematopoietic cell transplantation in children.
abstract: Childhood autologous hematopoietic cell transplant (auto-HCT) survivors can be at risk for secondary malignant neoplasms (SMNs). We assembled a cohort of 1487 pediatric auto-HCT recipients to investigate the incidence and risk factors for SMNs. Primary diagnoses included neuroblastoma (39%), lymphoma (26%), sarcoma (18%), central nervous system tumors (14%) and Wilms tumor (2%). Median follow-up was 8 years (range, <1-21 years). SMNs were reported in 35 patients (AML/myelodysplastic syndrome (MDS)=13, solid cancers=20, subtype missing=2). The overall cumulative incidence of SMNs at 10 years from auto-HCT was 2.60% (AML/MDS=1.06%, solid tumors=1.30%). We found no association between SMNs risk and age, gender, diagnosis, disease status, time since diagnosis or use of TBI or etoposide as part of conditioning. OS at 5-years from diagnosis of SMNs was 33% (95% confidence interval (CI), 16-52%). When compared with age- and gender-matched general population, auto-HCT recipients had 24 times higher risks of developing SMNs (95% CI, 16.0-33.0). Notable SMN sites included bone (N=5 SMNs, observed (O)/expected (E)=81), thyroid (N=5, O/E=53), breast (N=2, O/E=93), soft tissue (N=2, O/E=34), AML (N=6, O/E=266) and MDS (N=7, O/E=6603). Risks of SMNs increased with longer follow-up from auto-HCT. Pediatric auto-HCT recipients are at considerably increased risk for SMNs and need life-long surveillance for SMNs.
authors.affiliation: Department of Hematology and Oncology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Danner-Koptik
authors.forename: N S
authors.initials: NS
authors.lastname: Majhail
authors.forename: R
authors.initials: R
authors.lastname: Brazauskas
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Buchbinder
authors.forename: J-Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: K J
authors.initials: KJ
authors.lastname: Dilley
authors.forename: H A
authors.initials: HA
authors.lastname: Frangoul
authors.forename: T G
authors.initials: TG
authors.lastname: Gross
authors.forename: G A
authors.initials: GA
authors.lastname: Hale
authors.forename: R J
authors.initials: RJ
authors.lastname: Hayashi
authors.forename: N
authors.initials: N
authors.lastname: Hijiya
authors.forename: R T
authors.initials: RT
authors.lastname: Kamble
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.forename: B N
authors.initials: BN
authors.lastname: Savani
authors.forename: A B
authors.initials: AB
authors.lastname: Warwick
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
authors.forename: W A
authors.initials: WA
authors.lastname: Wood
authors.forename: M L
authors.initials: ML
authors.lastname: Sorror
authors.forename: D A
authors.initials: DA
authors.lastname: Jacobsohn
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014182:Transplantation, Autologous; D055815:Young Adult