title: Subsequent malignant neoplasms in pediatric patients initially diagnosed with neuroblastoma.
abstract: BACKGROUND
  Most prior studies evaluating subsequent malignant neoplasms (SMNs) in patients with neuroblastoma are restricted to long-term survivors and/or their treatment exposures. This study investigates SMNs in patients diagnosed with neuroblastoma at our institution.
  
  
  METHODS
  Records of 646 patients treated for neuroblastoma at St Jude Children's Research Hospital between 1961 and 2005 were reviewed. Data from patients with SMNs were analyzed and the 20- and 30-year cumulative incidence of SMNs and standardized incidence ratio were calculated.
  
  
  RESULTS
  Twenty-one patients had a SMN. The 20- and 30-year cumulative incidences of a SMN were 2.6%±0.7% and 4.6%±1.1%, respectively. The standardized incidence ratio was 8.3 (95% confidence interval, 5.0-13.0). Five patients developed a SMN within 5 years from diagnosis. The median latency for the development of acute myeloid leukemia/myelodysplastic syndrome (n=4), sarcomas (n=7), and carcinomas (n=5) were 3.6, 9, and 24.2 years, respectively. Nine patients died from their SMN, including all with acute myeloid leukemia/myelodysplastic syndrome.
  
  
  CONCLUSIONS
  Patients with neuroblastoma have an increased risk of secondary neoplasia. Modification of risk-adapted therapies will likely alter the affected patient population and the incidence of SMNs. Future studies are necessary to link SMNs to treatment exposures and to evaluate the risk of SMNs beyond 30 years from diagnosis.
authors.affiliation: Departments of *Oncology §Biostatistics ∥Pathology, St Jude Children's Research Hospital †Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN ‡Department of Oncology, Duke University, Durham, NC.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Federico
authors.forename: Heather B
authors.initials: HB
authors.lastname: Allewelt
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Spunt
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Billups
authors.forename: Jesse
authors.initials: J
authors.lastname: Jenkins
authors.forename: Victor M
authors.initials: VM
authors.lastname: Santana
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Furman
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McGregor
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D009447:Neuroblastoma / Q000150:complications*; D012306:Risk