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This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bhatia, S. Articles by Robison, L. L. Search for Related Content PubMed PubMed Citation Articles by Bhatia, S. Articles by Robison, L. L. Related Collections Plenary Papers Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 June 2002, Vol. 99, No. 12, pp. 4257-4264 PLENARY PAPER Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983 Smita Bhatia, Harland N. Sather, Olga B. Pabustan, Michael E. Trigg, Paul S. Gaynon, and Leslie L. Robison From the City of Hope National Medical Center, Duarte, CA; Dupont Hospital for Children, Wilmington, DE; University of Minnesota, Minneapolis; Childrens Hospital Los Angeles; and Keck School of Medicine, University of Southern California, both of Los Angeles, CA. Second malignant neoplasms are a serious complication after successful treatment of childhood acute lymphoblastic leukemia (ALL). With improvement in survival, it is important to assess the impact of contemporary risk-based therapies on second neoplasms in ALL survivors. A cohort of 8831 children diagnosed with ALL and enrolled on Children's Cancer Group therapeutic protocols between 1983 and 1995 were observed to determine the incidence of second neoplasms and associated risk factors. The median age at diagnosis of ALL was 4.7 years. The cohort had accrued 54 883 person-years of follow-up. Sixty-three patients developed second neoplasms, including solid, nonhematopoietic tumors (n = 39: brain tumors n = 19, other solid tumors n = 20), myeloid leukemia or myelodysplasia (n = 16), and lymphoma (n = 8). The cumulative incidence of any second neoplasm was 1.18% at 10 years (95% confidence interval, 0.8%-1.5%), representing a 7.2-fold increased risk compared with the general population. The risk was increased significantly for acute myeloid leukemia (standardized incidence ratio [SIR] 52.3), non-Hodgkin lymphoma (SIR 8.3), parotid gland tumors (SIR 33.4), thyroid cancer (SIR 13.3), brain tumors (SIR 10.1), and soft tissue sarcoma (SIR 9.1). Multivariate analysis revealed female sex (relative risk [RR] 1.8), radiation to the craniospinal axis (RR 1.6), and relapse of primary disease (RR 3.5) to be independently associated with increased risk of all second neoplasms. Risk of second neoplasms increased with radiation dose (1800 cGy RR 1.5; 2400 cGy RR 3.9). Actuarial survival at 10 years from diagnosis of second neoplasms was 39%. Follow-up of this large cohort that was treated with contemporary risk-based therapy showed that the incidence of second neoplasms remains low after diagnosis of childhood ALL. © 2002 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: K. Schmiegelow, I. Al-Modhwahi, M. K. Andersen, M. Behrendtz, E. Forestier, H. Hasle, M. Heyman, J. Kristinsson, J. Nersting, R. Nygaard, et al. Methotrexate/6-mercaptopurine maintenance therapy influences the risk of a second malignant neoplasm after childhood acute lymphoblastic leukemia: results from the NOPHO ALL-92 study Blood, June 11, 2009; 113(24): 6077 - 6084. [Abstract] [Full Text] [PDF] A. T. Meadows, D. L. Friedman, J. P. Neglia, A. C. Mertens, S. S. Donaldson, M. Stovall, S. Hammond, Y. Yasui, and P. D. 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