Second malignancy after treatment of childhood acute myeloid leukemia

To investigate the cumulative incidence of second malignancy and the compet ing risk of death due to any other cause in patients who were treated for c hildhood acute myeloid leukemia (AML), we analyzed the outcomes in a cohort of 501 patients who were treated at St Jude Children's Research Hospital b etween 1970 and 1996, Five patients developed a second cancer (two carcinom as of the parotid gland, one non-Hodgkin's lymphoma, one supratentorial pri mitive neuroectodermal tumor, one acute lymphoblastic leukemia) as compared with 0.47 expected in the general population (standardized incidence ratio , 10.64; 95% confidence interval, 3.28 to 22.34), A third neoplasm (meningi oma) developed in one patient. At 15 years after the diagnosis of AML, the estimated cumulative incidence of second malignancy was 1.34% +/- 0.61%, wh ereas the cumulative incidence of death due to any other cause was 72.96% /- 2.14%, We concluded that although a more than 10-fold increased risk of development of cancer was found in survivors of childhood AML as compared t o the general population, the risk of this late complication is small when compared to the much larger risk of death because of the primary leukemia o r the early complications of its treatment. Future studies should focus on improving treatments for primary AML while preventing second malignancies.