Abstract
BackgroundAcute lymphoblastic leukemia (ALL) is more common in children than in adults. Secondary neoplasms (SNs) in childhood ALL have been widely reported. However, only one study has demonstrated SNs in adult ALL. Because of the poorer survival of adult ALL, the incidence might be underestimated.ObjectiveTo evaluate the incidence and risk factors of secondary solid organ neoplasms among adult and child ALL patients.MethodsNewly diagnosed ALL patients between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent or combined malignancies were excluded. Standardized incidence ratios (SIRs) were analyzed to compare the risk of our cohort to general population in the same age, sex and calendar year. Risk factors for SN development were analyzed by Cox proportional hazards models. Effects of treatments were treated as time-dependent variables.ResultsThe 15-year cumulative incidence of SN was 1.9% and 8.4% in 1,381 child and 2,154 adult ALL patients, respectively. The SIR was significantly increased in child ALL (SIR 6.06), but not in adult ALL (SIR 1.16). The SIRs of follow-up periods were 5.14, 2.24, .87 and .71 at ≥ 10 years, 5–10 years, 1–5 years and 0–1, respectively. Overall, 15 SNs developed, and CNS tumors (SIR 11.56) were the most common type. Multivariate analysis showed that age ≥ 20 years (hazard ratio [HR] 5.04), end-stage renal disease (HR 18.98) and cranial irradiation (HR 8.12) were independent risk factors for cancer development.ConclusionsWhen compared with the general population, child ALL shows a increased risk of developing SNs. CNS tumors are the most common type, and cranial irradiation is an independent risk factor. With longer follow-up, the risk of SNs increases. Hence, physicians need to pay more attention on the risk of developing SNs in long-term ALL survivors with risk factors.
Highlights
Acute lymphoblastic leukemia (ALL) accounts for about 25% of all childhood cancers, and is the most common leukemia in children [1], but represents less than 20% of adult acute leukemia
Multivariate analysis showed that age 20 years, end-stage renal disease (HR 18.98) and cranial irradiation (HR 8.12) were independent risk factors for cancer development
Our study demonstrates that the 15-year cumulative incidence of secondary neoplasms (SNs) is 8.4% in adult ALL and 1.9% in in child ALL, which is compatible with previous studies
Summary
Acute lymphoblastic leukemia (ALL) accounts for about 25% of all childhood cancers, and is the most common leukemia in children [1], but represents less than 20% of adult acute leukemia. With the increased survival of ALL, long-term complications have been observed [3, 4], such as anthracycline-induced cardiomyopathy [5], cranial irradiation-induced neurocognitive deficits [6] and endocrine abnormalities [7]. Apart from these late sequelae, secondary neoplasms (SNs) are a serious complication for ALL survivors. Of these SNs in child ALL, hematologic malignancies [8,9,10] and CNS tumors [11,12,13,14] are most commonly reported. Because of the poorer survival of adult ALL, the incidence might be underestimated
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