{Author 1 (Prefix):11.2} {Author 1 (Last):11.6}

TitelSecond malignant neoplasms after treatment of 1487 children and adolescents with acute lymphoblastic leukemia – A population-based analysis of the Austrian ALL-BFM Study Group
Einleitung

Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood and adolescence. With 5-year overall survival (OS) rates reaching 90%, the number of long-term survivors has risen, and it becomes increasingly important to not only focus on leukemia-free survival, but also on the quality of survival by evaluating the long-term toxicity of pediatric ALL treatment. SMNs cause considerable morbidity and, after relapse, are the main cause of death for ALL patients, making it imperative to reduce risk factors for their development without compromising ALL treatment efficacy. Herein, we present data on incidence, type, risk factors and outcome of SMNs in a population-based cohort of pediatric ALL patients treated according to Berlin-Frankfurt-Münster (BFM)-based protocols in Austria.

Patient/en und Methoden

Between January 1981 and December 2009, 1487 children and adolescents <23-years-old with newly diagnosed ALL were enrolled in one of six multicenter trials in Austria (A): ALL-BFM-A 81 (n=141), ALL-A 84 (n=127), ALL-BFM-A 86 (n=142), ALL-BFM-A 90 (n=256), ALL-BFM-A 95 (n=230) and ALL-BFM-A 2000 (n=591). The aim of this study was to determine the incidence and characteristics of SMNs as a first event for all children treated with BFM-based treatments for primary ALL in either of the 6 trials. Data collected about the SMNs included clinical, histological, therapy, and outcome parameters.

Ergebnisse

Among 1487 ALL patients diagnosed between 1981 and 2010 in Austria, the 10-year cumulative incidence of an SMN was 1.1±0.3%. There was no difference in the 10-year incidence of SMNs with regard to diagnostic-, response- and therapy-related ALL characteristics except for a significantly higher incidence in patients with leukocytes ≥50.0 G/L at ALL diagnosis (2.1±1.0% vs. 0% for 20.0–50.0 G/L, and 1.0±0.3 for <20.0 G/L; p=0.033). Notably, there was no significant difference in the incidence of SMNs between patients with or without cranial radiotherapy (1.2±0.5% vs. 0.8±0.3%; p=0.295). The 10-year OS rate for the 19 patients with a SMN was 55.0±12.7%.

Schlussfolgerung/Diskussion

Future strategies must decrease the incidence of SMNs and aim to establish standardized surveillance programs to detect SMNs as early as possible, as this event still leads to death in one-third (7/19) of the patients.

Autor*in 1Fiona Poyer Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital
Autor*in 2Karin Dieckmann Department of Radiotherapy, Medical University of Vienna
Autor*in 3Michael Dworzak Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital
Autor*in 4Melanie Tamesberger Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz
Autor*in 5Oskar Haas Labdia Diagnostics, Vienna
Autor*in 6Neil Jones Department of Pediatrics and Adolescent Medicine, University Clinics Salzburg
Autor*in 7Karin Nebral Labdia Diagnostics, Vienna
Autor*in 8Stefan Köhrer Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital
Autor*in 9Reinhard Moser Department of Pediatrics and Adolescent Medicine, State Hospital Leoben
Autor*in 10Gabriele Kropshofer Division of Pediatric Hematology and Oncology and Stem Cell Transplantation, Department of Pediatrics and Adolescent Medicine, Medical University of Innsbruck
Autor*in 11Christina Peters Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital
Autor*in 12Christian Urban Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz
Autor*in 13Georg Mann Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital
Autor*in 14Ulrike Pötschger St. Anna Children's Cancer Research Institute (CCRI), Vienna
Autor*in 15Andishe Attarbaschi Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital