Children with low-risk acute lymphoblastic leukemia are at highest risk of second cancers

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BACKGROUND: The improved survival rates for childhood acute lymphoblastic leukemia (ALL) may be jeopardized by the development of a second cancer, which has been associated with thiopurine therapy.

PROCEDURE: We retrospectively analyzed three sequential Nordic Society of Paediatric Haematology and Oncology's protocols characterized by increasing intensity of thiopurine-based maintenance therapy. We explored the risk of second cancer in relation to protocols, risk group, thiopurine methyltransferase (TPMT) activity, ALL high hyperdiploidy (HeH), and t(12;21)[ETV6/RUNX1].

RESULTS: After median 9.5 years (interquartile range, 5.4-15.3 yrs) of follow-up, 40 of 3,591 patients had developed a second cancer, of whom 38 had non-high-risk B-cell precursor ALL. Patients with standard-risk ALL, who received the longest maintenance therapy, had the highest adjusted hazard of second cancer (hazard ratio [HR], intermediate vs. standard risk: 0.16, 95% CI: 0.06-0.43, P <0.001; (adjusted (n="3,368);" 0.02-0.49, 0.09, 0.54-3.76, 0.69-5.96, 1.43, 2.02, 95% a activity age, all an analysis association at blood cancer cell ci: clinical count diagnosis, did effect effects either explored from hazard heh heh, high hr hr, in increased low maintenance no not observed observed. of on or p="0.47).</p" patients protocol, reaching remission risk: runx1] second show significant standard standard-risk subset t(12;21) t(12;21)[etv6 the therapy tpmt vs. was were white with>

CONCLUSIONS: The rate of second cancer was generally highest in patients with low-risk ALL, but we could not identify a subset at higher risk than others.

Original languageEnglish
Article numbere26518
JournalPediatric Blood & Cancer
Issue number10
Pages (from-to)1-9
Number of pages9
Publication statusPublished - Oct 2017

    Research areas

  • Adolescent, Antineoplastic Combined Chemotherapy Protocols, Child, Chromosomes, Human, Pair 12, Chromosomes, Human, Pair 21, Female, Follow-Up Studies, Humans, Male, Methyltransferases, Neoplasms, Second Primary, Ploidies, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Retrospective Studies, Risk Factors, Translocation, Genetic, Journal Article

ID: 184633904