Abstract
Pediatric acute lymphoblastic leukemia (ALL) patients have higher rates of second primary malignancies. There is limited data on second primary malignancies (SPM) among adult patients with ALL. This study was conducted to evaluate SPM in adult ALL patients using US Surveillance, Epidemiology and End Results (SEER) cancer registry database.
We analyzed the SEER 13 Registries using multiple primary standardized incidence ratio (MP-SIR) session. We analyzed secondary cancer rates among adult ALL patients during the period 1992 - 2010. We used SEER*Stat software provided by national cancer institute for statistical analysis.
There were 3,259 adult (age ≥20 years) ALL patients reported in SEER database during 1992-2010. Among them, 65 ALL patients developed 75 second primary malignancies. Fifty-nine ALL patients developed 1 SPM each, 3 ALL patients developed 2 SPM each, 2 ALL patients developed 3 SPM each and 1 ALL patient developed 4 SPM. All site cancers were significantly higher among adult ALL patients compared to general population with observed/expected ratio (O/E): 1.47, p value< 0.05, an absolute excess risk of 24.43 per 10,000 populations. Similarly, oral cavity cancer, respiratory system cancer and hematological SPM were significantly higher in ALL patients than expected in general population. (Table)
Second primary malignancy in ALL
| Second Primary Malignancy . | Persons with ALL : 3,259 Person Years : 9,863.62 . | ||||
|---|---|---|---|---|---|
| Observed . | O/E . | CIs . | Excess Risk . | Mean Age at Event . | |
| All Sites | 75 | 1.47# | 1.16-1.85 | 24.43 | 60.47 |
| All Sites excluding Non-Melonoma Skin | 75 | 1.48# | 1.16-1.85 | 24.64 | 60.47 |
| Oral Cavity and Pharynx | 7 | 5.42# | 2.18-11.17 | 5.79 | 59.18 |
| Small Intestine | 2 | 9.55# | 1.16-34.51 | 1.82 | 69.25 |
| Respiratory System | 14 | 2.17# | 1.18-3.63 | 7.64 | 70.47 |
| Lung and Bronchus | 13 | 2.18# | 1.16-3.73 | 7.14 | 69.61 |
| All Lymphatic and Hematopoietic Diseases | 16 | 3.60# | 2.06-5.85 | 11.72 | 47.83 |
| Leukemia | 13 | 10.05# | 5.35-17.87 | 11.87 | 49.94 |
| Non-Lymphocytic Leukemia | 11 | 16.44# | 8.21-29.42 | 10.47 | 50.22 |
| Acute Myeloid Leukemia | 7 | 18.46# | 7.42-38.03 | 6.71 | 52.37 |
| Chronic Myeloid Leukemia | 3 | 16.17# | 3.33-47.26 | 2.85 | 47.28 |
| Other Myeloid/Monocytic Leukemia | 1 | 64.71# | 1.64-360.53 | 1 | 44 |
| Second Primary Malignancy . | Persons with ALL : 3,259 Person Years : 9,863.62 . | ||||
|---|---|---|---|---|---|
| Observed . | O/E . | CIs . | Excess Risk . | Mean Age at Event . | |
| All Sites | 75 | 1.47# | 1.16-1.85 | 24.43 | 60.47 |
| All Sites excluding Non-Melonoma Skin | 75 | 1.48# | 1.16-1.85 | 24.64 | 60.47 |
| Oral Cavity and Pharynx | 7 | 5.42# | 2.18-11.17 | 5.79 | 59.18 |
| Small Intestine | 2 | 9.55# | 1.16-34.51 | 1.82 | 69.25 |
| Respiratory System | 14 | 2.17# | 1.18-3.63 | 7.64 | 70.47 |
| Lung and Bronchus | 13 | 2.18# | 1.16-3.73 | 7.14 | 69.61 |
| All Lymphatic and Hematopoietic Diseases | 16 | 3.60# | 2.06-5.85 | 11.72 | 47.83 |
| Leukemia | 13 | 10.05# | 5.35-17.87 | 11.87 | 49.94 |
| Non-Lymphocytic Leukemia | 11 | 16.44# | 8.21-29.42 | 10.47 | 50.22 |
| Acute Myeloid Leukemia | 7 | 18.46# | 7.42-38.03 | 6.71 | 52.37 |
| Chronic Myeloid Leukemia | 3 | 16.17# | 3.33-47.26 | 2.85 | 47.28 |
| Other Myeloid/Monocytic Leukemia | 1 | 64.71# | 1.64-360.53 | 1 | 44 |
Excess risk is per 10,000 US populations, Confidence intervals are 95%, # P value< 0.05.
Adult patients with ALL have higher rates of second primary malignancies compared to general population.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
