Second cancers and late mortality in Australian children treated by allogeneic HSCT for haematological malignancy

• Published in: Leukemia Vol. 29; no. 2; pp. 441 - 447
• Main Authors: Nelson, A S, Ashton, L J, Vajdic, C M, Le Marsney, R E, Daniels, B, Nivison-Smith, I, Wilcox, L, Dodds, A J, O'Brien, T A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2015; Nature Publishing Group
• Subjects: 692/699/67/1990; 692/699/67/2324; 692/700/1720; 692/700/565/545/576/1955; Adolescent; Australia; Blood cancer; Cancer; Cancer Research; Care and treatment; Child; Child, Preschool; Cohort Studies; Conditioning; Confidence intervals; Critical Care Medicine; Female; Genetic aspects; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Health aspects; Health risks; Hematologic Neoplasms - complications; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - mortality; Hematology; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Incidence; Infant; Intensive; Internal Medicine; Male; Malignancy; Medicine; Medicine & Public Health; Mortality; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - etiology; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - mortality; Oncology; original-article; Pediatrics; Population; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Radiation; Recurrence; Risk; Risk Factors; Stem cell transplantation; Stem cells; Survival; Thyroid; Thyroid cancer; Time Factors; Transplantation; Transplantation Conditioning - methods; Transplants & implants; Treatment Outcome; Australia
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2014.203

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.