Secondary malignancy

The retinoid isotretinoin (68) has been found to reduce the incidence of secondary malignancies in patients treated for head and neck cancer. In addition, the use of trans-m m.oic acid in patients having M3 leukemia has been reported to induce complete, although temporary, remissions (32). 

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potential cure for SCD. The best candidates are children with SCD who are younger than 16 years of age with severe complications who have an identical H LA-matched donor, usually a sibling. The transplant-related mortality rate is between 5% and 10%, and graft rejection is approximately 10%. Other risks include secondary malignancies, development of seizures or intracranial bleeding, and infection in the immediate posttransplant period.6,25,32,33... 

Each category of chemotherapy drugs has similar side effects. Anthracyclines cause cardiac toxicity, which is related to the cumulative dose. Tubulin interactive agents are associated with neuropathy and ileus. Alkylating agents are associated with secondary malignancies. 

Risk factors for the development of AML include exposure to environmental toxins, Hispanic ethnicity, and genetics.6 Of greater concern is the increased prevalence of AML as a secondary malignancy, resulting from chemotherapy and radiation treatment for other cancers. Alkylating agents, such as ifosfamide and cyclophosphamide, and topoisomerase inhibitors, such as etoposide, are linked to an increased risk of myelodysplastic syndrome (MDS) and AML.8... 

Ionizing radiation therapy is also a cause of secondary malignancies. These secondary tumors generally develop within or adjacent to the previous radiation field. These cancers often have... 

Unlike children, adults may have other factors that predispose them to secondary malignancies. Lifestyle choices such as tobacco use, alcohol use, and diet have been implicated in influencing the development of secondary neoplasms in the adult population. 

Now that 80% or more of children survive their primary cancers, the incidence of secondary neoplasms may increase. Recognizing this potential, many treatment regimens for children are being modified appropriately to reduce exposure to alkylators, topoisomerase inhibitors, and radiation. Late effects clinics screen for secondary malignancies and other disease and treatment-related disabilities that accompany childhood cancer. Similar screening and educational opportunities are not currently established in adult survivors. 

Melphalan (Alkeran) Myelosuppression, secondary malignancies, pulmonary fibrosis, sterility, alopecia Dose of 0.15 mg/kg for 7 days given orally once daily, repeated every 4-6 weeks IV formulation used for stem cell transplantation... 

Long-term survivors of HCT should be monitored closely, particularly for infections and secondary malignant neoplasms. 

Allogeneic hematopoietic stem cell transplantation is the only therapy that is curative. The best candidates are younger than 16 years of age, have severe complications, and have human leukocyte antigen-matched donors. Risks must be carefully considered and include mortality, graft rejection, and secondary malignancies. 

Long-term complications of radiotherapy, chemotherapy, and chemora-diotherapy include gonadal dysfunction, secondary malignancies, and cardiac disease. Patients treated for HL are at increased risk of developing leukemia, GI tumors, lung cancer, and breast cancer. 

Increased susceptibility to infection and secondary malignancy OBRA regulated in U.S. Long Term Care... 

With regard to long-term toxicity, some reports in the literature have suggested a relationship of secondary malignancies after treatment of childhood ALL with TPMT /TPMT and TPMTVTPMT phenotypes. In a study at St. Jude Children s Research Hospital, SJCRH Total XlllHR, patients with lower TPMT activity showed a trend towards a higher incidence of AML associated with application of the topoiso-merase II inhibitor etoposide (203). 

In contrast, successful TPMT genotyping of 72 patients out of a total of 115 patients with subsequent secondary malignant neoplasms after treatment for childhood ALL on seven consecutive BFM protocols (ALL-BFM 79, 81, 83, 86, 90, 95, and 2000) did not reveal a higher frequency of TPMT alleles associated with lower TPMT activity among these patients (208). Also, in stratified analyses by entities of secondary malignant neoplasms, no significant associations with TPMT alleles conferring lower enzyme activity have been observed. 

Stanulla M, Schaeffeler E, Moricke A et al. Thiopurine methyltransferase genotype is not a risk factor for secondary malignant neoplasias after treatment for childhood acute lymphoblastic leukemia on Berlin FrankfurtMunster protocols. Blood 2006 108 48a. 

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