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. 2008 Apr 15;111(8):4014-21.
doi: 10.1182/blood-2007-08-106021. Epub 2008 Feb 7.

Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study

Elizabeth C Bluhm  1 , Cécile Ronckers, Robert J Hayashi, Joseph P Neglia, Ann C Mertens, Marilyn Stovall, Anna T Meadows, Pauline A Mitby, John A Whitton, Sue Hammond, Joseph D Barker, Sarah S Donaldson, Leslie L Robison, Peter D Inskip
Affiliations

Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study

Elizabeth C Bluhm et al. Blood. .

Abstract

Second primary malignancies and premature death are a concern for patients surviving treatment for childhood lymphomas. We assessed mortality and second malignant neoplasms (SMNs) among 1082 5-year survivors of non-Hodgkin lymphoma (NHL) in the Childhood Cancer Survivor Study, a multi-institutional North American retrospective cohort study of cancer survivors diagnosed from 1970 to 1986. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated using US population rates. Relative risks for death and solid tumor SMNs were calculated based on demographic, clinical, and treatment characteristics using Poisson regression models. There were 87 observed deaths (SMR = 4.2; 95% CI, 1.8-4.1) with elevated rates of death from solid tumors, leukemia, cardiac disease, and pneumonia. Risk for death remained elevated beyond 20 years after NHL. Risk factors for death from causes other than NHL included female sex (rate ratio [RR] = 3.4) and cardiac radiation therapy exposure (RR = 1.9). There were 27 solid tumor SMNs (SIR = 3.9; 95% CI, 2.6-5.7) with 3% cumulative incidence between 5 and 20 years after NHL diagnosis. Risk factors were female sex (RR = 3.1), mediastinal NHL disease (RR = 5.2), and breast irradiation (RR = 4.3). Survivors of childhood NHL, particularly those treated with chest RT, are at continued increased risk of early mortality and solid tumor SMNs.

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Figures

Figure 1
Figure 1
Cumulative incidence of second neoplasms among 1074 5-year survivors of pediatric non-Hodgkin lymphoma, Childhood Cancer Survivor Study, North America. The dashed line represents cumulative incidence of all malignant diagnoses, including bladder transitional cell carcinoma in situ, whereas the solid line includes diagnoses listed above in addition to 4 meningiomas (ICD-O-2: 9532.0, 953.0), 21 skin cancers (ICD-O-2: 8090.3, 8094.3), and one myelodysplastic syndrome (ICD-O-2: 9989.1). Only the first of any of these neoplasms is counted for each subject. Subjects were those alive 5 years after NHL diagnosis, excluding 6 who experienced secondary neoplasms within the first 5 years of NHL and 2 with unknown date of death.
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