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Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan

BACKGROUND: Acute 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 underestimate...

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Autores principales: Teng, Chung-Jen, Huon, Leh-Kiong, Hu, Yu-Wen, Yeh, Chiu-Mei, Chien, Sheng-Hsuan, Chen, San-Chi, Liu, Chia-Jen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817987/
https://www.ncbi.nlm.nih.gov/pubmed/27035574
http://dx.doi.org/10.1371/journal.pone.0152909
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author Teng, Chung-Jen
Huon, Leh-Kiong
Hu, Yu-Wen
Yeh, Chiu-Mei
Chien, Sheng-Hsuan
Chen, San-Chi
Liu, Chia-Jen
author_facet Teng, Chung-Jen
Huon, Leh-Kiong
Hu, Yu-Wen
Yeh, Chiu-Mei
Chien, Sheng-Hsuan
Chen, San-Chi
Liu, Chia-Jen
author_sort Teng, Chung-Jen
collection PubMed
description BACKGROUND: Acute 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. OBJECTIVE: To evaluate the incidence and risk factors of secondary solid organ neoplasms among adult and child ALL patients. METHODS: Newly 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. RESULTS: The 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. CONCLUSIONS: When 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.
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spelling pubmed-48179872016-04-19 Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan Teng, Chung-Jen Huon, Leh-Kiong Hu, Yu-Wen Yeh, Chiu-Mei Chien, Sheng-Hsuan Chen, San-Chi Liu, Chia-Jen PLoS One Research Article BACKGROUND: Acute 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. OBJECTIVE: To evaluate the incidence and risk factors of secondary solid organ neoplasms among adult and child ALL patients. METHODS: Newly 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. RESULTS: The 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. CONCLUSIONS: When 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. Public Library of Science 2016-04-01 /pmc/articles/PMC4817987/ /pubmed/27035574 http://dx.doi.org/10.1371/journal.pone.0152909 Text en © 2016 Teng et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Teng, Chung-Jen
Huon, Leh-Kiong
Hu, Yu-Wen
Yeh, Chiu-Mei
Chien, Sheng-Hsuan
Chen, San-Chi
Liu, Chia-Jen
Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title_full Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title_fullStr Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title_full_unstemmed Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title_short Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan
title_sort secondary solid organ neoplasm in patients with acute lymphoblastic leukemia: a nationwide population-based study in taiwan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817987/
https://www.ncbi.nlm.nih.gov/pubmed/27035574
http://dx.doi.org/10.1371/journal.pone.0152909
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