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. 2015 Jan;62(1):128-33.
doi: 10.1002/pbc.25249. Epub 2014 Sep 23.

Second malignancies in patients with neuroblastoma: the effects of risk-based therapy

Mark A Applebaum  1 , Tara O Henderson, Sang Mee Lee, Navin Pinto, Samuel L Volchenboum, Susan L Cohn
Affiliations

Second malignancies in patients with neuroblastoma: the effects of risk-based therapy

Mark A Applebaum et al. Pediatr Blood Cancer. 2015 Jan.

Abstract

Background: To investigate the incidence of second malignant neoplasms (SMN) for patients with neuroblastoma, we analyzed patients from the SEER database according to three treatment eras (Era 1: 1973-1989, Era 2: 1990-1996, and Era 3: 1997-2006) corresponding to the introduction of multi-agent chemotherapy, risk-based treatment, and stem cell transplant.

Procedures: The SEER database was mined for all patients with neuroblastoma or ganglioneuroblastoma. Cumulative incidence of SMN was calculated with death as a competing risk. A poisson regression model was used to estimate incidence rate ratios and 95% confidence intervals to compare the rates of SMN between patients in different Eras.

Results: The analytic cohort included 2,801 patients. Thirty-four patients developed a SMN, accounting for 1.2% of all patients. Of the patients who developed a SMN, 47.1% received radiation for their primary neuroblastoma. Fourteen of the SMN were carcinomas, and 10 were hematologic malignancies, with six cases of acute myelogenous leukemia. There was no difference in the incidence of SMN in Era 1 compared to Era 3 (P = 0.48). The cumulative incidence of SMN at 30 years for high-risk patients was 10.44% (95% CI 3.98-20.52%) compared to 3.57% (95% CI 1.87-6.12%) for non-high-risk patients (P < 0.001).

Conclusions: This study showed no increase in the incidence of SMNs for children treated in the most recent treatment era as compared to earlier Eras. However, as the risk for developing SMN does not plateau, the number of SMNs will likely continue to rise in the cohort of patients treated after 1996. Comprehensive follow-up care for these survivors will be important.

Keywords: SEER; late effects; neuroblastoma; second malignancies.

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Conflict of interest statement

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Cumulative incidence of second malignant neoplasms from time of diagnosis in 2,801 patients diagnosed with neuroblastoma.
Figure 2
Figure 2
Cumulative incidence of second malignant neoplasms in patients alive five years from initial diagnoses evaluated by risk group.
Figure 3
Figure 3
Kaplan-Meier estimates of overall survival from time of diagnosis according to neuroblastoma risk group and treatment era.
See this image and copyright information in PMC

References

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