FaCD Online Syndrome Fact Sheet

Last updated: 29 Aug 2008

Name: Childhood Leukemia and Lymphoma, Mulitple Primary Malignancies in Patients with

Tumor features

brain tumor
breast cancer
Hodgkin disease (Hodgkin's lymphoma)
leukemia
non-Hodgkin lymphoma
skin cancer
thyroid cancer

Comment

Maule et al.[1] quantified the risks of second malignant neoplasms in an international group of over 16500 survivors of childhood (0-14 years) leukemia and lymphoma. The particular histological subtypes were not reported.
The most frequent malignancies occurring after leukemia were brain cancer (SIR = 8.52, 95% CI = 5.13 to 13.3), non-Hodgkin lymphoma (SIR = 9.41, 95% CI = 4.30 to 17.9), and thyroid cancer (SIR = 18.8, 95% CI = 8.60 to 35.7).
The most frequent tumors diagnosed after Hodgkin lymphoma were thyroid cancer (SIR = 52.5, 95% CI = 24.0 to 99.6), breast cancer (SIR = 20.9, 95% CI = 7.66 to 45.4), and non-melanoma skin cancer (non-melanoma) (SIR = 34.0, 95% CI = 12.5 to 74.0).
The most frequent diagnosed after non-Hodgkin lymphoma were thyroid cancer (SIR = 40.4, 95% CI = 14.8 to 88.0) and brain cancer (SIR = 6.97, 95% CI = 1.90 to 17.9).

Cumulative incidence of any second malignant neoplasm was 2.43% (95% CI = 1.09 to 3.78), 12.7% (95% CI = 8.29 to 17.2), and 2.50% (95% CI = 1.04 to 3.96) within 30 years from diagnosis of leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma, respectively.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal,...) related effects
- Possible bias because of increased surveillance and autopsy findings

References

[1] Maule M, Scélo G, Pastore G, Brennan P, Hemminki K, Tracey E, Sankila R, Weiderpass E, Olsen JH, McBride ML, Brewster DH, Pompe-Kirn V, Kliewer EV, Chia KS, Tonita JM, Martos C, Jonasson JG, Merletti F, Boffetta P. Risk of second malignant neoplasms after childhood leukemia and lymphoma: an international study. Journal of the National Cancer Institute 2007; 99(10):790-800.