Format

Send to

Choose Destination
Eur J Cancer. 2019 Aug;117:71-83. doi: 10.1016/j.ejca.2019.05.013. Epub 2019 Jun 28.

Risk of subsequent primary leukaemias among 69,460 five-year survivors of childhood cancer diagnosed from 1940 to 2008 in Europe: A cohort study within PanCareSurFup.

Author information

1
Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin. Electronic address: rodrigue.allodji@gustaveroussy.fr.
2
Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK.
3
Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.
4
Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy.
5
Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
6
Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France.
7
Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
8
St Anna Kinderspital Wien, Austria; Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria.
9
Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark.
10
Boyne Research Institute, Drogheda, Ireland.
11
Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
12
Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden.
13
German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany.
14
Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland.
15
Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland.
16
Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Via Cadore 38, 20900 Monza, MB, Italy.
17
Norwegian National Advisory Unit on Solid Tumors in Children, Norway.
18
Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, And Northern Institute of Cancer Research, Newcastle University, Newcastle Upon Tyne, UK.
19
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
20
Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
21
Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary.
22
Turku University and Turku University Hospital, Department of Pediatric and Adolescent Medicine, Turku, Finland.
23
Institute of Oncology, Ljubljana, Slovenia.
24
Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
25
Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
26
Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France.

Abstract

BACKGROUND:

Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors.

METHODS:

This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated.

RESULTS:

One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs.

CONCLUSIONS:

We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.

KEYWORDS:

Childhood cancer survivors; Lymphoid leukaemias; Myeloid leukaemias; Second cancers; Subsequent primary leukaemia

PMID:
31260818
DOI:
10.1016/j.ejca.2019.05.013

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center