Journal
BONE MARROW TRANSPLANTATION
Volume 48, Issue 3, Pages 363-368Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bmt.2012.166
Keywords
hematopoietic cell transplantation; autologous; pediatric; second cancers; risk factors
Categories
Funding
- Public Health Service Grant/Cooperative Agreement from the National Cancer Institute (NCI) [U24-CA76518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- NHLBI [5U01HL069294]
- NCI
- Health Resources and Services Administration (HRSA/DHHS) [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- Allos, Inc.
- Amgen, Inc.
- Angioblast
- anonymous donation to the Medical College of Wisconsin
- Ariad
- Be the Match Foundation
- Blue Cross and Blue Shield Association
- Buchanan Family Foundation
- CaridianBCT
- Celgene Corporation
- CellGenix, GmbH
- Children's Leukemia Research Association
- Fresenius-Biotech North America, Inc.
- Gamida Cell Teva Joint Venture Ltd
- Genentech, Inc.
- Genzyme Corporation
- GlaxoSmithKline
- Kiadis Pharma
- Leukemia and Lymphoma Society
- Medical College of Wisconsin
- Millennium Pharmaceuticals, Inc.
- Milliman USA, Inc.
- Miltenyi Biotec, Inc.
- National Marrow Donor Program
- Optum Healthcare Solutions, Inc.
- Osiris Therapeutics, Inc.
- Otsuka America Pharmaceutical, Inc.
- RemedyMD
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix, Inc.
- Swedish Orphan Biovitrum
- Tarix Pharmaceuticals
- Teva Neuroscience, Inc.
- THERAKOS, Inc.
- Wellpoint, Inc.
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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. Bone Marrow Transplantation (2013) 48, 363-368; doi:10.1038/bmt.2012.166; published online 10 September 2012
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