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Lymphoma

Second malignant neoplasms after treatment of non-Hodgkin’s lymphoma—a retrospective multinational study of 189 children and adolescents

Leukemia volume 35, pages 534–549 (2021)Cite this article

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Abstract

Data on the spectrum of second malignant neoplasms (SMNs) after primary childhood non-Hodgkin’s lymphoma (NHL) are scarce. One-hundred-and-eighty-nine NHL patients diagnosed in a 30 years period of 1980–2010 developing an SMN were retrieved from 19 members of the European Intergroup for Childhood NHL and/or the international Berlin-Frankfurt-Münster Study Group. Five subgroups of SMNs were identified: (1) myeloid neoplasms (n = 43; 23%), (2) lymphoid neoplasms (n = 51; 27%), (3) carcinomas (n = 48; 25%), (4) central nervous system (CNS) tumors (n = 19; 10%), and (5) “other” SMNs (n = 28; 15%). In 37 patients (20%) preexisting disorders were reported with 90% having any kind of cancer predisposition syndrome (CPS). For the 189 primary NHL patients, 5-year overall survival (OS) after diagnosis of an SMN was 56 ± 4%, being worst for patients with preexisting disorders at 28 ± 8%. Five-year OS rates were 38 ± 8%, 59 ± 7%, 79 ± 8%, 34 ± 12%, and 62 ± 11%, respectively, for patients with myeloid and lymphoid neoplasms, carcinomas, CNS tumors, and “other” SMNs (p < 0.0001). Patients with SMNs after childhood NHL having a reported CPS, mostly mismatch repair disorders, carried a very poor prognosis. Moreover, although outcome was favorable in some subtypes of SMNs after childhood NHL (carcinomas, lymphoid neoplasms), other SMNs such as myeloid neoplasms and CNS tumors had a dismal prognosis.

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Fig. 1: Kaplan-Meier estimates and cumulative incidence curves of the subgroups of the 189 patients with NHL and an SMN.
Fig. 2: Kaplan-Meier estimates of the whole cohort of 189 patients with NHL and an SMN and of the 37 patients with preexisting disorders.

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Acknowledgements

We thank all participating institutions and physicians for their support of the study. This EICNHL and i-BFM paper was written on behalf of the Berlin-Frankfurt-Münster (BFM) Study Group (Austria, Germany, Switzerland, Czech Republic), Associazione Italiana Ematologia e Oncologia Pediatrica (AIEOP), Société Française de Lutte contre les Cancers et Leucémies de l’Enfant (SFCE), United Kingdom Children’s Cancer and Leukemia Study Group (CCLG), Belgian Society of Pediatric Hematology and Oncology, Dutch Childhood Oncology Group (DCOG), Nordic Society of Pediatric Hematology and Oncology (NOPHO), Hungarian Pediatric Oncology Network, Slovenian Society of Hematology and Oncology, Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG), Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hellenic Society of Pediatric Hematology and Oncology (HeSHOP), Israel’s Society of Pediatric Hematology and Oncology, Spanish Society of Pediatric Hematology and Oncology (SEHOP), and two single institutions from Belarus (Minsk) and Russia (Moscow).

This work was supported by Cancer Research United Kingdom, the Deutsche Kinderkrebsstiftung (BB and WW), DKS 2014.11A/B, DKS 2016.24A/B (BFM Germany), the St. Anna Kinderkrebsforschung (AA, BFM Austria), the Czech Ministry of Health supported project for conceptual development of research organization 00064203 (EK, BFM Czech Republic), and the Ministry of Health, Labour and Welfare of Japan (TO, JPLSG).

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, Vienna, Austria

    Andishe Attarbaschi & Leila Ronceray

  2. Department of Pediatric Hematology and Oncology, University of Padova, Padova, Italy

    Elisa Carraro & Marta Pillon

  3. Department of Pediatric Hematology and Oncology, University La Fe Hospital, Valencia, Spain

    Mara Andrés

  4. Department of Pediatric Hematology and Oncology, Schneider Children’s Medical Center of Israel, Petah-Tikva, Israel

    Shlomit Barzilai-Birenboim

  5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shlomit Barzilai-Birenboim

  6. Wolfson Childhood Cancer Center, Newcastle University, Newcastle, UK

    Simon Bomken

  7. Department of Pediatric and Adolescent Oncology, Gustave-Roussy Cancer Center, Paris-Saclay University, Villejuif, France

    Laurence Brugières & Charlotte Rigaud

  8. Pediatric Hematology and Oncology, University-Hospital of Münster, Münster, Germany

    Birgit Burkhardt

  9. Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland

    Francesco Ceppi

  10. Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong

    Alan K. S. Chiang

  11. Department of Pediatric Hematology and Oncology, Semmelweis University, Budapest, Hungary

    Monika Csoka

  12. Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus

    Alina Fedorova

  13. Division of Pediatrics, Hematology and Oncology, University Medical Center Ljubljana, Ljubljana, Slovenia

    Janez Jazbec

  14. Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic

    Edita Kabickova

  15. Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands

    Jan Loeffen

  16. Department of Pediatric Hematology and Oncology, The Queen Silvia’s Hospital for Children and Adolescents, University of Gothenburg, Gothenburg, Sweden

    Karin Mellgren

  17. Department of Pediatric Hematology and Oncology, Federal Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

    Natalia Miakova

  18. Department of Pediatric Hematology and Oncology, Rheinisch-Westfälische Technische Hochschule (RWTH)-Aachen University, Aachen, Germany

    Olga Moser

  19. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    Tomoo Osumi

  20. Department of Oncology, “P & A. Kyriakou” Children’s Hospital, Athens, Greece

    Apostolos Pourtsidis

  21. Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium

    Anne Uyttebroeck

  22. Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Wilhelm Woessmann

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  1. Andishe Attarbaschi
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On behalf of the European Intergroup for Childhood Non-Hodgkin’s Lymphoma (EICNHL) and the International Berlin-Frankfurt-Münster (i-BFM) Study Group

Contributions

AA and MP designed and planned the study; AA and MP wrote the paper; AA, EC, LR, and MP were in charge of data pooling, data checking, and statistical analysis; all other authors (MA, SBB, SB, LB, BB, FC, AC, AP, MC, AF, JJ, EK, JL, NM, KM, OM, TO, CR, AU, WW) as well as AA and MP were principal or co-investigators in their study groups and institutions, coordinated the national trials in their countries, provided study materials, and recruited patients. All authors read and approved the final version of the paper.

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Correspondence to Andishe Attarbaschi.

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Attarbaschi, A., Carraro, E., Ronceray, L. et al. Second malignant neoplasms after treatment of non-Hodgkin’s lymphoma—a retrospective multinational study of 189 children and adolescents. Leukemia 35, 534–549 (2021). https://doi.org/10.1038/s41375-020-0841-x

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