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Therapy and Competing Risks in Childhood AML

Second malignancy after treatment of childhood acute myeloid leukemia

Leukemia volume 15, pages 41–45 (2001)Cite this article

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.

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Acknowledgements

This work was supported in part by grants CA-20180 and CA-21765 from the National Institutes of Health, by a Center of Excellence grant from the State of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC). We thank Dr Julia Cay Jones for scientific editing, Ms Annette Stone for data management, and Ms Pam Hays for registry management.

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Authors and Affiliations

  1. After Completion of Therapy Program, St Jude Children's Research Hospital, Memphis, TN, USA

    W Leung & M Hudson

  2. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    W Leung, RC Ribeiro, M Hudson, JE Rubnitz, JT Sandlund, BI Razzouk & C-H Pui

  3. University of Tennessee, College of Medicine, Memphis, TN, USA

    W Leung, RC Ribeiro, M Hudson, JE Rubnitz, JT Sandlund, BI Razzouk, WE Evans & C-H Pui

  4. Department of Biostatistics and Epidemiology, St Jude Children's Research Hospital, Memphis, TN, USA

    X Tong & DK Srivastava

  5. Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    WE Evans

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Leung, W., Ribeiro, R., Hudson, M. et al. Second malignancy after treatment of childhood acute myeloid leukemia. Leukemia 15, 41–45 (2001). https://doi.org/10.1038/sj.leu.2401948

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