title: Second cancers and late mortality in Australian children treated by allogeneic HSCT for haematological malignancy.
abstract: We examined risk of second cancer and late mortality in a population-based Australian cohort of 717 pediatric allogeneic stem cell transplant (HSCT) recipients treated for a malignant disease during 1982-2007. Record linkage with population-based death and cancer registries identified 17 second cancers at a median of 7.9 years post HSCT; thyroid cancer being the most common malignancy (n=8). The cumulative incidence of second cancer was 8.7% at follow-up, and second cancers occurred 20 times more often than in the general population (standardised incidence ratio 20.3, 95% confidence interval (CI)=12.6-32.7). Transplantation using radiation-based conditioning regimens was associated with increased second cancer risk. A total of 367 patients survived for at least 2 years post HSCT and of these 44 (12%) died at a median of 3.1 years after HSCT. Relapse was the most common cause of late mortality (n=32). The cumulative incidence of late mortality was 14.7%. The observed rate of late mortality was 36 times greater than in the matched general population (standardised mortality ratio 35.9, 95% CI=26.7-48.3). Recipients who relapsed or who had radiation-based conditioning regimens were at higher risk of late mortality. Second cancers and late mortality continue to be a risk for pediatric patients undergoing HSCT, and these results highlight the need for effective screening and survivorship programs.
authors: 1] Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia [2] School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.
authors: A S
authors: AS
authors: Nelson
authors: Research Portfolio, University of Sydney, Sydney, New South Wales, Australia.
authors: L J
authors: LJ
authors: Ashton
authors: Prince of Wales Clinical School, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia.
authors: C M
authors: CM
authors: Vajdic
authors: Children's Cancer Institute Australia for Medical Research, Lowy Cancer Centre, University of New South Wales, Randwick, New South Wales, Australia.
authors: R E
authors: RE
authors: Le Marsney
authors: Prince of Wales Clinical School, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia.
authors: B
authors: B
authors: Daniels
authors: Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, New South Wales, Australia.
authors: I
authors: I
authors: Nivison-Smith
authors: Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, New South Wales, Australia.
authors: L
authors: L
authors: Wilcox
authors: Department of Haematology and Stem Cell Transplantation, St Vincents Hospital, Darlinghurst, New South Wales, Australia.
authors: A J
authors: AJ
authors: Dodds
authors: 1] Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia [2] School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.
authors: T A
authors: TA
authors: O'Brien
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome