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Pediatria Polska - Polish Journal of Paediatrics
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4/2024
vol. 99
 
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abstract:
Original paper

Incidence of secondary malignancies in Polish children treated for acute lymphoblastic leukemia according to the ALL-IC BFM 2002 protocol

Kamila Wypyszczak
1
,
Agata Pastorczak
2
,
Jerzy Kowalczyk
3
,
Tomasz Szczepański
4
,
Monika Lejman
5
,
Walentyna Balwierz
6
,
Bernarda Kazanowska
7
,
Katarzyna Derwich
8
,
Elżbieta Adamkiewicz-Drożyńska
9
,
Joanna Trelińska
10
,
Andrzej Kołtan
11
,
Maryna Krawczuk-Rybak
12
,
Tomasz Ociepa
13
,
Tomasz Urasiński
13
,
Grażyna Sobol-Milejska
14
,
Grażyna Karolczyk
15
,
Paweł Łaguna
16
,
Jan Styczyński
11
,
Jacek Wachowiak
8
,
Wojciech Młynarski
17

  1. Department of Genetic Predisposition to Cancer, Medical University of Lodz, Poland
  2. Department of Genetic Predisposition to Cancer, Department of Pediatrics, Oncology and Hematology, Central Clinical Hospital, Lodz, Poland
  3. Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
  4. Department of Pediatrics, Hematology and Oncology, Medical University of Zabrze, Zabrze, Poland
  5. Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
  6. Department of Pediatric Oncology and Hematology, Children’s University Hospital, Jagiellonian University, Krakow, Poland
  7. Department of Pediatric Transplantology, Oncology, Hematology, Medical University of Wroclaw, Wroclaw, Poland
  8. Department of Pediatric Oncology, Hematology and Transplantology, Medical University of Poznan, Poznan, Poland
  9. Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
  10. Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
  11. Department of Pediatrics, Hematology and Oncology, Collegium Medicum of Bydgoszcz, Bydgoszcz, Poland
  12. Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
  13. Department of Pediatrics, Hemato-Oncology and Pediatric Gastroenterology, Medical University of Szczecin, Szczecin, Poland
  14. Department of Pediatrics, Medical University of Katowice, Katowice, Poland
  15. Department of Pediatric Oncology and Hematology, Children’s Hospital, Kielce, Poland
  16. Department of Pediatric Oncology, Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, Warsaw, Poland
  17. Department of Pediatrics, Oncology and Hematology, Central Clinical Hospital, Lodz, Poland
Pediatr Pol 2024; 99 (4): 291-296
DOI: https://doi.org/10.5114/polp.2024.146417
Online publish date: 2024/12/30
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Introduction:
Acute lymphoblastic leukemia (ALL) is the most commonly diagnosed childhood cancer, with a peak incidence around 5 years of age. Aim of the study was to assess the incidence, type, and outcome of secon­dary malignancies in children who were primarily treated for ALL.

Material and methods:
We enrolled in the analysis 1868 children uniformly treated for ALL between 2 October 2002 and 22 December 2012 according to the protocol ALL-IC BFM 2002. In this study group, we assessed the incidence and type of secondary cancer and outcome.

Results:
We identified 12 patients (0.64%) who developed secondary malignancies after the median time of 1.72 years from the primary diagnosis of ALL (range: 11.5 months to 18 years). The most frequently diagnosed second neoplasms were hematological malignancies (8 out of 12; 66.7%) including acute myeloid leukemia (AML) (n = 4), non-Hodgkin lymphoma (NHL) (n = 2), chronic myeloid leukemia (CML) (n = 1), and leukemia of unknown immunophenotype (n = 1). In total, four children developed subsequent solid tumors: Ewing sarcoma (n = 1), primitive neuroectodermal tumor (n = 1), myeloid sarcoma (n = 1), and solid tumors of unknown origin (n = 1). Children diagnosed with second cancer were non-significantly older at primary ALL diagnosis in comparison with patients without second cancer (12.083 [3.4–14.0] vs. 5.25 [3.2–10.2]; p = 0.063). The risk group distribution differed between patients with and without a second cancer: 2 (16.67%) vs. 606 (32.65%) children were assigned to the standard risk (SR) group, 5 (41.67%) vs. 894 (48.17%) in the intermediate risk (IR) group, and 5 (41.67%) vs. 356 (19.18%) in the high risk (HR) group. Patients with secondary malignancies showed a significantly lower probability of 5-year overall survival as compared to children without subsequent tumors: 26.5% vs. 85.7%; p < 10–5; HR = 5.9; 95% CI: 2.91–11.96.

Conclusions:
Blood cancers are the most frequently observed malignancies in children treated for ALL during the first 3 years after treatment completion. Diagnosis of secondary tumor after being treated for ALL is related to poor outcome.

keywords:

pediatric acute lymphoblastic leukemia, secondary neoplasm, ALL-IC BFM 2002

  
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