儿童急性淋巴细胞白血病 5 年幸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.
发表日期：2024 Aug 28
作者：
Aimée S R Westerveld, Pien Roesthuis, Helena J H van der Pal, Dorine Bresters, Marc Bierings, Jacqueline Loonen, Andrica C H de Vries, Marloes Louwerens, Maria M W Koopman, Marry M van den Heuvel-Eibrink, Margriet van der Heiden-van der Loo, Peter Hoogerbrugge, Geert O Janssens, Ronald R de Krijger, Cecile M Ronckers, Rob Pieters, Leontien C M Kremer, Jop C Teepen
来源：
Blood Cancer Journal
摘要：
急性淋巴细胞白血病（ALL）幸存者有发生后续肿瘤的风险，但有关后续恶性肿瘤（SMN）和后续非恶性肿瘤（SNMN）的长期风险和危险因素的信息有限。我们分析了荷兰儿童癌症幸存者研究后期队列（1963-2014）中 3291 名 5 年 ALL 幸存者的 SMN 和 SNMN 的长期风险和危险因素。我们计算了标准化发病率 (SIR) 和累积发病率，并使用多变量 Cox 比例风险回归分析来分析风险因素。共有 97 名幸存者出现 SMN，266 名幸存者出现 SNMN。 SMN 的 30 年累积发病率为 4.1%（95%CI：3.5-5.3），SNMN 的 30 年累积发病率为 10.4%（95%CI：8.9-12.1）。与一般人群相比，SMN 的风险较高（SIR：2.6，95%CI：2.1-3.1）。接受造血干细胞移植（HSCT）并全身照射（TBI）（HR：4.2，95％CI：2.3-7.9）和未接受TBI（HR：4.0，95％CI：1.2-13.7）的幸存者显示SMN增加与非移植幸存者的风险。颅脑放射治疗（CRT）也是 SMN 的危险因素（HR：2.1，95％CI：1.4-4.0）。总之，儿童 ALL 幸存者的 SMN 风险增加，尤其是在 HSCT 和 CRT 后。一项重要发现是，即使是接受 HSCT 治疗但未接受 TBI 治疗的幸存者，SMN 风险也会增加，这可能是由于伴随化疗所致。这强调了对 HSCT 和/或 CRT 治疗的幸存者进行仔细随访的必要性。© 2024。作者。
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.© 2024. The Author(s).