Table 5.
Standardized incidence ratios and relative risks for solid second malignant neoplasms by demographic and disease characteristics and by type of treatment among 1082 five-year survivors of pediatric non-Hodgkin lymphoma (NHL): Childhood Cancer Survivor Study, North America
| All solid malignancies, n = 27 |
|||
|---|---|---|---|
| O | SIR (95% CI) | RR (95% CI) | |
| Overall risk | 27 | 3.9 (2.6, 5.7) | NA |
| Sex | |||
| Male | 10 | 2.3 (1.1, 4.3) | 1.0 |
| Female | 17 | 6.8 (3.9, 10.8) | 2.2 (1.0, 5.2) |
| Age at NHL diagnosis, y | |||
| 0-4 | 1 | ||
| 5-9 | 5 | 3.6 (1.2, 8.4) | 1.1 (0.3, 3.4) |
| 10-14 | 12 | 5.2 (2.7, 9.0) | 1.8 (0.7, 4.6) |
| 15-21 | 9 | 3.4 (1.5, 6.4) | 1.0 |
| NHL treatment era | |||
| 1970-1973 | 5 | 3.2 (1.0, 7.6) | 1.0 |
| 1974-1977 | 4 | 2.0 (0.5, 5.1) | 1.0 (0.2, 4.9) |
| 1978-1981 | 10 | 5.4 (2.6, 9.8) | 2.8 (0.8, 12.4) |
| 1982-1986 | 8 | 5.6 (2.4, 11.1) | 2.8 (0.8, 13.2) |
| P trend = .032 | |||
| NHL histopathology or cell type | |||
| Burkitt/Burkitt-like | 0 | 0 (0, 3.0) | ND |
| Lymphoblastic | 6 | 4.6 (1.7, 10.0) | 1.5 (0.4, 6.0) |
| Diffuse large cell | 10 | 5.4 (2.6, 10.0) | 1.9 (0.6, 7.0) |
| Others specified | 6 | 6.3 (2.3, 13.7) | 1.7 (0.4, 7.3) |
| Unspecified | 5 | 3.3 (1.1, 7.7) | 1.0 |
| Primary site of NHL | |||
| LN/hematopoietic | 10 | 3.0 (2.9, 7.1) | 1.0 |
| GI | 1 | ND | ND |
| Head and neck, including brain | 2 | 3.0 (0.3, 10.8) | 0.6 (0.3, 3.0) |
| Mediastinum | 7 | 14.6 (5.8, 30.0) | 4.6 (1.6, 12.5) |
| Unknown primary/others | 7 | 5.7 (2.3, 11.8) | 1.8 (0.6, 5.0) |
| Treatment exposures* | |||
| Any RT | 21 | 4.7 (2.9, 7.1) | 2.1 (0.9, 4.8) |
| Breast exposure to RT† | 12 | 11.8 (6.1, 20.6) | 7.5 (2.6, 26.7) |
| Thyroid exposure to RT | 10 | 7.4 (3.5, 13.5) | 2.6 (1.0, 7.1) |
| Any CT | 24 | 4.6 (2.9, 6.8) | Unable |
| COMP | 18 | 4.9 (2.9, 7.8) | Unable |
| Ara-C | 13 | 6.0 (3.2, 10.2) | 2.4 (1.0, 5.6) |
| Doxorubicin | 9 | 5.4 (2.4, 10.2) | 1.6 (0.7, 3.7) |
| Epipodophyllotoxins | 2 | 5.4 (0.6, 19.4) | 1.2 (0.2, 4.2) |
| Bleomycin | 2 | 4.8 (0.5, 17.4) | 0.9 (0.1, 3.2) |
| Platinum drugs | 1 | ND | 4.6 (0.3, 23.5) |
| Bone marrow transplantation | 2 | 14.9 (1.7, 53.8) | 3.6 (0.6, 112.5) |
O indicates observed; SIR, standardized incidence ratio; CI, confidence interval; RR, rate ratio, based on Poisson regression (RR analyses adjusted for RT and sex); NA, not applicable; ND, not determined.
RT, radiation therapy; CT, chemotherapy; COMP, cyclophosphamide, vincristine, methotrexate, and prednisone. Referent in each drug/regimen is all subjects unexposed to that drug/regimen. Treatment results are adjusted for NHL pathology and sex. CT and BMT results are additionally adjusted for RT.
Breast exposure includes shielded breast exposure. Because of sparse data, model for breast exposure did not account for gastrointestinal tract of head and neck sites.