January 2001, Volume 15, Issue 1, Pages 41 - 45

Original Manuscript

Second malignancy after treatment of childhood acute myeloid leukemia W Leung1,2,3, RC Ribeiro2,3, M Hudson1,2,3, X Tong4, DK Srivastava4, JE Rubnitz2,3, JT Sandlund2,3, BI Razzouk2,3, WE Evans3,5 & C-H Pui2,3 1After Completion of Therapy Program, St Jude Children’s Research Hospital, Memphis, TN, USA     2Department of Hematology-Oncology, St Jude Children’s Research Hospital, Memphis, TN, USA     3University of Tennessee, College of Medicine, Memphis, TN, USA     4Department of Biostatistics and Epidemiology, St Jude Children’s Research Hospital, Memphis, TN, USA     5Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN, USA     Correspondence to: W Leung, St Jude Children’s Research Hospital, 332 N Lauderdale Street, Memphis, TN 38105, USA; Fax: 901 521 9005

Keywords

second malignancy;   childhood AML;   competing risk

Abstract

To investigate the cumulative incidence of second malignancy and the competing risk of death due to any other cause in patients who were treated for childhood acute myeloid leukemia (AML), we analyzed the outcomes in a cohort of 501 patients who were treated at St Jude Children’s Research Hospital between 1970 and 1996. Five patients developed a second cancer (two carcinomas of the parotid gland, one non-Hodgkin’s lymphoma, one supratentorial primitive neuroectodermal tumor, one acute lymphoblastic leukemia) as compared with 0.47 expected in the general population (standardized incidence ratio, 10.64; 95% confidence interval, 3.28 to 22.34). A third neoplasm (meningioma) developed in one patient. At 15 years after the diagnosis of AML, the estimated cumulative incidence of second malignancy was 1.34% ± 0.61%, whereas the cumulative incidence of death due to any other cause was 72.96% ± 2.14%. We concluded that although a more than 10-fold increased risk of development of cancer was found in survivors of childhood AML as compared to the general population, the risk of this late complication is small when compared to the much larger risk of death because of the primary leukemia or the early complications of its treatment. Future studies should focus on improving treatments for primary AML while preventing second malignancies. Leukemia (2001) 15, 41-45.

Received 28 July 2000; Accepted 22 August 2000

^© Macmillan Publishers Ltd 2001