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Epidemiology and Virology

Second cancers and late mortality in Australian children treated by allogeneic HSCT for haematological malignancy

Leukemia volume 29, pages 441–447 (2015)Cite this article

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Abstract

We examined risk of second cancer and late mortality in a population-based Australian cohort of 717 pediatric allogeneic stem cell transplant (HSCT) recipients treated for a malignant disease during 1982–2007. Record linkage with population-based death and cancer registries identified 17 second cancers at a median of 7.9 years post HSCT; thyroid cancer being the most common malignancy (n=8). The cumulative incidence of second cancer was 8.7% at follow-up, and second cancers occurred 20 times more often than in the general population (standardised incidence ratio 20.3, 95% confidence interval (CI)=12.6–32.7). Transplantation using radiation-based conditioning regimens was associated with increased second cancer risk. A total of 367 patients survived for at least 2 years post HSCT and of these 44 (12%) died at a median of 3.1 years after HSCT. Relapse was the most common cause of late mortality (n=32). The cumulative incidence of late mortality was 14.7%. The observed rate of late mortality was 36 times greater than in the matched general population (standardised mortality ratio 35.9, 95% CI=26.7–48.3). Recipients who relapsed or who had radiation-based conditioning regimens were at higher risk of late mortality. Second cancers and late mortality continue to be a risk for pediatric patients undergoing HSCT, and these results highlight the need for effective screening and survivorship programs.

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Acknowledgements

This work was supported by a project grant from the National Health and Medical Research Council (NHMRC ID568775), the Arrow Bone Marrow Transplant Foundation, Australia, an NHMRC Career Development Fellowship (ID1023159 to CMV) and a Cancer Institute New South Wales Career Development Fellowship (ID 10/CDF/2-42 to CMV).

Author contributions

LJA and CMV designed the research. TAO’B and LJA coordinated the research. RELM and BD analysed the data. ASN, LJA, CMV, RELM, BD, LW, IN-S and TAO’B interpreted the data. ASN, CMV and TAO’B wrote the manuscript and all authors contributed to and approved the final manuscript.

Members of CAST Study Group

L Ashton (Research Portfolio, University of Sydney), RE Le Marnsey (Cancer Institute Australia, New South Wales); A Dodds, J Tan, I Bilmon (St Vincent’s Hospital, New South Wales); L Wilcox, I Nivison-Smith, D Aarons, S Tran (ABMTRR), C Vajdic (University of New South Wales); J Gibson A Johnston (Royal Prince Alfred Hospital, New South Wales); M Greenwood, M Forbes (Royal North Shore Hospital, New South Wales); M Hertzberg, G Huang (Westmead Hospital, New South Wales); A Spencer, J Muirhead (Alfred Hospital, Victoria); J Szer, K Mason (Royal Melbourne Hospital, Victoria); I Lewis, C To (Royal Adelaide Hospital, South Australia); S Durrant, R Western (Royal Brisbane and Women’s Hospital, Queensland); P Cannell, S Buffery (Royal Perth Hospital, Western Australia); T O’Brien, C Oswald, AS Nelson (Sydney Children’s Hospital, New South Wales); P Shaw, L Pearson (Children’s Hospital at Westmead, New South Wales); K Tiedemann, M Scoyne (Royal Children’s Hospital Melbourne, Victoria); C Fraser, J Seljak (Royal Children’s Hospital Brisbane, Queensland); C Cole, K Rowland, H Gough (Princess Margaret Hospital for Children, Western Australia); H Tapp, N Green (Women and Children’s Hospital, South Australia). Data collectors: RE Le Marsney, A Moa, J McRae and M Jenkins (Children’s Cancer Institute Australia, New South Wales); J Hicks (Royal Melbourne Hospital, Victoria); K Chaplin (Royal Adelaide Hospital, South Australia).

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Author notes

  1. Members of the CAST study group are listed above the references.

Authors and Affiliations

  1. Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia

    A S Nelson & T A O'Brien

  2. School of Women’s & Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia

    A S Nelson & T A O'Brien

  3. Research Portfolio, University of Sydney, Sydney, New South Wales, Australia

    L J Ashton

  4. Prince of Wales Clinical School, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia

    C M Vajdic & B Daniels

  5. Children’s Cancer Institute Australia for Medical Research, Lowy Cancer Centre, University of New South Wales, Randwick, New South Wales, Australia

    R E Le Marsney

  6. Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, New South Wales, Australia

    I Nivison-Smith & L Wilcox

  7. Department of Haematology and Stem Cell Transplantation, St Vincents Hospital, Darlinghurst, New South Wales, Australia

    A J Dodds

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  1. A S Nelson
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on behalf of the CAST study investigators

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Correspondence to T A O'Brien.

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Nelson, A., Ashton, L., Vajdic, C. et al. Second cancers and late mortality in Australian children treated by allogeneic HSCT for haematological malignancy. Leukemia 29, 441–447 (2015). https://doi.org/10.1038/leu.2014.203

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