Second malignancy after treatment of childhood non-Hodgkin lymphoma

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Abstract
BACKGROUND The objective of this report was to determine the cumulative incidence of and risk factors for second malignancy and the competing risk of death due to any other cause among patients who were treated for childhood non‐Hodgkin lymphoma (NHL). METHODS The authors retrospectively reviewed a cohort of 497 patients with NHL who were treated at St. Jude Children's Research Hospital between 1970 and 1997. RESULTS A second malignancy developed in 16 patients (9 patients with solid tumors and 7 patients with secondary acute myeloid leukemia [AML]). This number was 10.8‐fold (95% confidence interval, 6.1–16.9) higher than the 1.48 patients projected for the general population by SEER Cancer Statistics. The estimated cumulative incidence rate of second malignancy was 2.1% ± 0.7% at 10 years after diagnosis of NHL and increased to 4.8% ± 1.3% at 20 years after diagnosis. The cumulative incidence rate of second malignancy was least among patients with small noncleaved cell lymphoma (0.5% ± 0.5% at 20 years), higher among patients with large cell lymphoma (5.8% ± 3.3% at 20 years), and highest among patients with lymphoblastic lymphoma (10.9% ± 3.6% at 20 years; P = 0.002 for overall comparison). Exposure to epipodophyllotoxins was a risk factor for the development of secondary AML (P < 0.001). The cumulative incidence rate of death due to other causes was significantly less for patients who were treated after June 1978 (19.9% ± 2.2% at 10 years) compared with patients who were treated earlier (55.6% ± 4.2% at 10 years; P < 0.001), whereas the risk of second malignancy was similar for these two eras. CONCLUSIONS Survivors of childhood NHL, especially those with lymphoblastic histology, are at a greater risk of developing a second malignancy compared with the general population. The incidence rate of second malignancy has remained unchanged despite a recent decline in the risk of death related to primary NHL or earlier treatment complications. Cancer 2001;92:1959–66. © 2001 American Cancer Society.