文章：

儿童急性淋巴细胞白血病5年生存者在造血干细胞移植后发生后续肿瘤的风险增加

Increased risk of subsequent neoplasm after hematopoietic stem cell transplantation in 5-year survivors of childhood acute lymphoblastic leukemia

原文发布日期：2024-08-28

DOI: 10.1038/s41408-024-01122-7

类型: Article

开放获取: 是

英文摘要：

Acute lymphoblastic leukemia (ALL) survivors are at risk for developing subsequent neoplasms, but there is limited information on long-term risks and risk factors for both subsequent malignant neoplasms (SMNs) and subsequent non-malignant neoplasms (SNMNs). We analyzed long-term risk and risk factors for SMNs and SNMNs among 3291 5-year ALL survivors from the Dutch Childhood Cancer Survivor Study-LATER cohort (1963–2014). We calculated standardized incidence ratios (SIRs) and cumulative incidences and used multivariable Cox proportional hazard regression analyses for analyzing risk factors. A total of 97 survivors developed SMNs and 266 SNMNs. The 30-year cumulative incidence was 4.1% (95%CI: 3.5–5.3) for SMNs and 10.4%(95%CI: 8.9–12.1) for SNMNs. Risk of SMNs was elevated compared to the general population (SIR: 2.6, 95%CI: 2.1–3.1). Survivors treated with hematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI) (HR:4.2, 95%CI: 2.3–7.9), and without TBI (HR:4.0,95%CI: 1.2–13.7) showed increased SMN risk versus non-transplanted survivors. Cranial radiotherapy (CRT) was also a risk factor for SMNs (HR:2.1, 95%CI: 1.4–4.0). In conclusion, childhood ALL survivors have an increased SMN risk, especially after HSCT and CRT. A key finding is that even HSCT-treated survivors without TBI treatment showed an increased SMN risk, possibly due to accompanied chemotherapy treatment. This emphasizes the need for careful follow-up of HSCT and/or CRT-treated survivors.
 

摘要翻译： 

急性淋巴细胞白血病（ALL）幸存者面临发生后续肿瘤的风险，但关于后续恶性肿瘤（SMNs）和后续非恶性肿瘤（SNMNs）的长期风险及风险因素的信息有限。我们对荷兰儿童癌症幸存者研究-LATER队列（1963–2014年）中3291名5年ALL幸存者的SMNs和SNMNs长期风险及风险因素进行了分析。我们计算了标准化发病率比（SIRs）和累积发病率，并采用多变量Cox比例风险回归分析风险因素。共有97名幸存者发生SMNs，266名发生SNMNs。30年累积发病率分别为：SMNs 4.1%（95%CI：3.5–5.3），SNMNs 10.4%（95%CI：8.9–12.1）。与普通人群相比，SMNs风险显著升高（SIR：2.6，95%CI：2.1–3.1）。接受含全身放疗（TBI）的造血干细胞移植（HSCT）治疗者（HR：4.2，95%CI：2.3–7.9）及不含TBI的HSCT治疗者（HR：4.0，95%CI：1.2–13.7）相较于未移植幸存者均表现出更高的SMN风险。颅脑放疗（CRT）同样是SMNs的风险因素（HR：2.1，95%CI：1.4–4.0）。结论表明，儿童ALL幸存者SMN风险增加，尤其在HSCT和CRT治疗后。关键发现是即使未接受TBI的HSCT治疗幸存者也表现出SMN风险升高，这可能归因于伴随的化疗。这强调了对HSCT和/或CRT治疗幸存者进行严密随访的必要性。

原文链接：

Increased risk of subsequent neoplasm after hematopoietic stem cell transplantation in 5-year survivors of childhood acute lymphoblastic leukemia