Fanconi anemia and solid malignancies in childhood: a national retrospective study.
BACKGROUND
Fanconi anemia (FA) predisposes to hematologic disorders and myeloid neoplasia in childhood and to solid cancers, mainly oral carcinomas, in early adulthood. Few cases of solid cancers have been reported in childhood.


METHODS
We conducted a national retrospective study of solid tumors occurring in patients registered with or determined to have FA during childhood in France. Phenotypic features, tumor type, cancer treatment, and outcome were analyzed. Whenever available, fresh-frozen tumors were analyzed by microarray-based comparative genomics hybridization.


RESULTS
We identified eight patients with FA with solid tumor from 1986 to 2012. For two patients, the diagnosis of FA was unknown at the time of cancer diagnosis. Moreover, we identified one fetus with a brain tumor. All patients showed failure to thrive and had dysmorphic features and abnormal skin pigmentation. Seven patients had BRCA2/FANCD1 mutations; five of these featured more than one malignancy and the median age at the time of cancer diagnosis was 11 months (range 0.4-3 years). Solid tumor types included five nephroblastomas, two rhabdomyosarcomas, two neuroblastomas, and three brain tumors. Two children died from the toxic effects of chemotherapy, two patients from the cancer, and one patient from secondary leukemia. Only one BRCA2 patient was alive more than 3 years after diagnosis, after tailored chemotherapy.


CONCLUSIONS
Solid tumors are rare in FA during childhood, except in patients with BRCA2/FANCD1 mutations. The proper genetic diagnosis is mandatory to tailor the treatment.
Department of Pediatrics, Curie Institute, Paris, France.
Aurore
A
Malric
Anne-Sophie
AS
Defachelles
Thierry
T
Leblanc
Brigitte
B
Lescoeur
Brigitte
B
Lacour
Michel
M
Peuchmaur
Claude-Alain
CA
Maurage
Gaëlle
G
Pierron
Delphine
D
Guillemot
Catherine Dubois
CD
d'Enghien
Jean
J
Soulier
Dominique
D
Stoppa-Lyonnet
Franck
F
Bourdeaut
D000293:Adolescent; D024682:BRCA2 Protein / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D055028:Comparative Genomic Hybridization; D018572:Disease-Free Survival; D005199:Fanconi Anemia / Q000188:drug therapy / Q000235:genetics / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000401:mortality; D008297:Male; D009154:Mutation; D020411:Oligonucleotide Array Sequence Analysis; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000235:genetics / Q000401:mortality; D015996:Survival Rate; D009396:Wilms Tumor / Q000188:drug therapy / Q000235:genetics / Q000401:mortality
D024682:BRCA2 Protein; C551750:BRCA2 protein, human
BRCA2; Fanconi anemia; cancer genetics; pediatric oncology; rhabdomyosarcoma