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. 2023 Feb 1;129(3):426-440.
doi: 10.1002/cncr.34561. Epub 2022 Nov 29.

Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study

Isabelle M Dudley  1 , Ceren Sunguc  1 , Emma J Heymer  1 , David L Winter  1 , Jop C Teepen  2 , Fabiën N Belle  3   4 , Edit Bárdi  5   6 , Francesca Bagnasco  7 , Thorgerdur Gudmundsdottir  8   9 , Roderick Skinner  10   11 , Gisela Michel  12 , Julianne Byrne  13 , Hilde Øfstaas  14 , Momcilo Jankovic  15 , Maja Česen Mazić  16 , Luzius Mader  3 , Jaqueline Loonen  17 , Stanislaw Garwicz  18 , Thomas Wiebe  18 , Daniela Alessi  19   20 , Rodrigue S Allodji  21 , Nadia Haddy  21 , Desiree Grabow  22 , Peter Kaatsch  22 , Melanie Kaiser  22 , Milena M Maule  19   20 , Zsuzsanna Jakab  23 , Maria Winther Gunnes  14   24 , Monica Terenziani  25 , Lorna Zadravec Zaletel  26 , Claudia E Kuehni  3   27 , Riccardo Haupt  28 , Florent de Vathaire  21 , Leontien C Kremer  2   29 , Päivi M Lähteenmäki  30 , Jeanette F Winther  8   31 , Lars Hjorth  18 , Michael M Hawkins  1 , Raoul C Reulen  1
Affiliations

Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study

Isabelle M Dudley et al. Cancer. .

Abstract

Background: Survivors of Hodgkin lymphoma (HL) are at risk of developing non-Hodgkin lymphoma (NHL) after treatment; however, the risks of developing subsequent primary lymphomas (SPLs), including HL and NHL, after different types of childhood cancer are unknown. The authors quantified the risk of SPLs using the largest cohort of childhood cancer survivors worldwide.

Methods: The Pan-European Network for Care of Survivors After Childhood and Adolescent Cancer (PanCare) Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 69,460 five-year survivors of childhood cancer, diagnosed during 1940 through 2008, from 12 European countries. Risks of SPLs were quantified by standardized incidence ratios (SIRs) and relative risks (RRs) using multivariable Poisson regression.

Results: Overall, 140 SPLs, including 104 NHLs and 36 HLs, were identified. Survivors were at 60% increased risk of an SPL compared with the general population (SIR, 1.6; 95% confidence interval [CI], 1.4-1.9). Survivors were twice as likely to develop NHL (SIR, 2.3; 95% CI, 1.9-2.8), with the greatest risks among survivors of HL (SIR, 7.1; 95% CI, 5.1-10.0), Wilms tumor (SIR, 3.1; 95% CI, 1.7-5.7), leukemia (SIR, 2.8; 95% CI, 1.8-4.4), and bone sarcoma (SIR, 2.7; 95% CI, 1.4-5.4). Treatment with chemotherapy for any cancer doubled the RR of NHL (RR, 2.1; 95% CI, 1.2-3.9), but treatment with radiotherapy did not (RR, 1.2; 95% CI, 0.7-2.0). Survivors were at similar risk of developing a subsequent HL as the general population (SIR, 1.1; 95% CI, 0.8-1.5).

Conclusions: In addition to HL, the authors show here for the first time that survivors of Wilms tumor, leukemia, and bone sarcoma are at risk of NHL. Survivors and health care professionals should be aware of the risk of NHL in these survivors and in any survivors treated with chemotherapy.

Keywords: Hodgkin lymphoma; childhood cancer survivors; late effects; non-Hodgkin lymphoma; second cancers; subsequent primary lymphoma.

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Conflict of interest statement

Zsuzsanna Jakab reports personal fees from Semmelweis Egyetem outside the submitted work. Lars Hjorth reports personal fees from Bayer and F. Hoffmann‐La Roche outside the submitted work. The remaining authors made no disclosures.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of developing a subsequent primary lymphoma (all types) for types of childhood cancer with at least 20 observed lymphomas, as a function of attained age.
See this image and copyright information in PMC

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