Second Malignant Neoplasms Following Multiple Myeloma: A Cohort Study On 744 Patients Treated 1997-2011

Abstract Introduction Second malignant neoplasms after first-line therapy and maintenance-therapy have been reported in clinical studies; however, no risk factors have been established. Moreover, second malignant neoplasms is gaining increasingly more attention as multiple myeloma patients live longer and data from randomized studies suggest there are associations between certain newer drugs and the risk of developing second malignant neoplasms. Clinical trials are not statically powered to define risk factors for second malignant neoplasms. Methods We have conducted a large study designed to define the rate of second malignant neoplasms in a well-characterized clinical multiple myeloma cohort. We identified 744 consecutive patients treated at our institution between 1997-2011 and analyzed 1. onset of second malignant neoplasms, 2. patient characteristics (age, gender, familiar risks, smoking status, immune status), 3. frequency of different neoplasms, 4. potential multiple myeloma specific risk factors and 5. possible treatment-related risk factors (novel agents, autologous stem cell transplantation [single vs. tandem (t)-ASCT], allogeneic (allo-) SCT, frequency of alkylating agents, cycles/lines of therapy and ionizing radiation). Results 118 (16%) multiple myeloma patients developed second malignant neoplasms. Prior or synchronous malignant neoplasms were observed in 83 patients (63%) and second malignant neoplasms developed subsequent to multiple myeloma in 49 (37%) patients. Overall, most (77%) of these neoplasms were solid tumors; whereas hematological neoplasms with 23% were prominently observed subsequent to multiple myeloma. Furthermore, multiple myeloma who developed second malignant neoplasms (versus those who did not) were older, predominantly male, had IgG-MM and more CTx-cycles, use of steroids, alkylators, lenalidomide/thalidomide and radiotherapy, but lacked laboratory abnormalities nor did they have more ASCTs or bortezomib therapy. The risk of dying of multiple myeloma due to disease progression remained substantially higher than that of developing a second malignant neoplasm (cumulative incidence at 20 years: 78% vs. 11%, respectively). However, since multiple myeloma prognosis increases and death at 20 years of follow-up decreases, the development of second malignant neoplasms remains highly relevant (Figure 1; comparison of the SEER database with our UKF data). Conclusions Matching the SEER database with our data (Figure 1) confirms the rate of second malignant neoplasms at 20 years of follow-up at around 10%, whereas death from other causes (multiple myeloma) seems to substantially decrease. Further comparison is currently under way and will expand our knowledge on the development of second malignant neoplasms. Our prior (Hasskarl J.,..Engelhardt M. 2011) and previous analyses suggest that physicians need to discuss individual risk-benefit ratios with patients and stay updated as more knowledge becomes available on this topic. It is likely that second malignant neoplasms in multiple myeloma patients remain important given that the prognosis in multiple myeloma has substantially increased and patients live significantly longer. Disclosures: Kleber: Celgene: Educational grant Other. Engelhardt:Celgene: Educational grant Other.

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The Shreveport Myeloma Experience: Survival, Risk Factors and Other Malignancies in the Age of Stem Cell Transplantation

Acta Haematologica ◽

10.1159/000440970 ◽

2015 ◽

Vol 135 (3) ◽

pp. 146-155 ◽

Cited By ~ 4

Author(s):

Reinhold Munker ◽

Runhua Shi ◽

Binu Nair ◽

Srinivas Devarakonda ◽

James D. Cotelingam ◽

...

Keyword(s):

Multiple Myeloma ◽

Autologous Transplantation ◽

Malignant Neoplasms ◽

New Agents ◽

Secondary Cancers ◽

Academic Center ◽

Seer Data ◽

Second Malignant Neoplasms ◽

Survival Risk

Background: The overall prognosis of multiple myeloma has improved significantly over the last 15 years. We wondered whether the overall improvement would also be seen in unselected patients in an academic center in Northwest Louisiana with a high proportion of minority patients, and if second malignant neoplasms are relevant for our patients. Materials and Methods: Between 1998 and 2009, 215 patients were treated for multiple myeloma at our center and had complete follow-up until May 2013. Results: The mean survival of patients with multiple myeloma increased from 3.25 to 5.34 years, which is comparable to patients treated at larger centers. No prognostic difference was observed in the subgroups of myeloma patients. Among 215 patients followed for the development of secondary cancers, 16 already had a preexisting or concomitant malignancy (7.4%) and 10 developed secondary cancers. Our data indicate a significant background of histologically unrelated cancers and a cumulative incidence of new cancers of about 20% after 10 years of follow-up. Based on SEER data, preexisting or secondary cancers were not statistically increased in our population. Conclusions: The use of autologous transplantation and the introduction of new agents resulted in a significant improvement in the prognosis of multiple myeloma. Other cancers are not statistically increased before or after multiple myeloma is diagnosed and are not prognostically relevant.

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Second Malignant Neoplasms in Patients With Rhabdomyosarcoma

Frontiers in Oncology ◽

10.3389/fonc.2021.757095 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hongnan Zhen ◽

Zhikai Liu ◽

Hui Guan ◽

Jiabin Ma ◽

Wenhui Wang ◽

...

Keyword(s):

Risk Factors ◽

Soft Tissues ◽

Survival Rates ◽

Malignant Neoplasm ◽

The United States ◽

Malignant Neoplasms ◽

Second Malignant Neoplasm ◽

Second Malignant Neoplasms ◽

Risk Patients ◽

Independent Risk Factors

ObjectiveRhabdomyosarcoma (RMS) is a rare malignant tumor. The main treatment modality is comprehensive with chemotherapy, radiotherapy, and surgery. With the advancement in recent decades, patient survival has been prolonged, and long-term complications are attracting increasing attention among both physicians and patients. This study aimed to present the survival of patients with RMS and analyze the risk factors for the development of a second malignant neoplasm (SMN).MethodsThe Surveillance, Epidemiology, and End Results (SEER) Program 18 registry database from 1973 to 2015 of the National Cancer Institute of the United States was used for the survival analyses, and the SEER 9 for the SMN analysis.ResultsThe 5-, 10-, and 20-year overall survival rates of the patients with RMS were 45%, 43%, and 33%, respectively. The risk of SMN was significantly higher in patients with RMS compared to the general population (SIR=1.95, 95% CI: 1.44 – 2.57, p < 0.001). The risk of developing SMN was increased in multiple locations, including the bones and joints (SIR = 35.25) soft tissues including the heart (SIR = 22.5), breasts (SIR = 2.10), male genital organs (SIR = 118.14), urinary system (SIR = 2.36), brain (SIR = 9.21), and all nervous system organs (SIR = 8.59). The multivariate analysis indicated that RMS in the limbs and earlier diagnosis time were independent risk factors for the development of SMN. Patients with head and neck (OR = 0.546, 95% CI: 0.313 – 0.952, p = 0.033) and trunk RMS (OR = 0.322, 95% CI: 0.184 – 0.564. p < 0.001) and a later diagnosis time were less likely to develop SMN (OR = 0.496, 95% CI: 0.421 – 0.585, p < 0.001).ConclusionThis study describes the risk factors associated with the development of SMN in patients with RMS, which is helpful for the personalized screening of high-risk patients with RMS.

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Population Trends in Incidence of Second Malignant Neoplasm and Cause-Specific Mortality in Patients with Multiple Myeloma

Blood ◽

10.1182/blood.v130.suppl_1.682.682 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 682-682

Author(s):

Luciano J. Costa ◽

Kelly N. Godby ◽

Saurabh Chhabra ◽

Robert Frank Cornell ◽

Parameswaran Hari ◽

...

Keyword(s):

Multiple Myeloma ◽

Hematopoietic Cell Transplantation ◽

Conflicts Of Interest ◽

Malignant Neoplasm ◽

Hematologic Malignancies ◽

Malignant Neoplasms ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background: The management of patients with multiple myeloma (MM) has evolved significantly over the last two decades with increased utilization of autologous hematopoietic cell transplantation (AHCT) and introduction of proteasome inhibitors (PIs) and immunomodulatory agents (IMIDs) and concomitant improvement in survival, particularly in younger patients. Both AHCT and the IMID lenalidomide have been associated with increased risk of second malignant neoplasms (SMN) in clinical trials, with the risk reaching 6.9% at 5 years in a recent meta-analysis. We intended to assess whether an increase in incidence of SMN was evident at the population level and the impact of the changing SMN risk on survival of MM patients. Methods: We utilized the Surveillance, Epidemiology and End Results 13 (SEER 13) registries to analyze three cohorts of patients: those diagnosed during 1995-1999 (pre-thalidomide, limited use of AHCT, 15 years of follow up), 2000-2004 (post-thalidomide, pre lenalidomide and bortezomib, increased utilization of AHCT, 10 years of follow up) and 2005-2009 (post-lenalidomide and bortezomib, higher utilization of AHCT, 5 years of follow up). Follow up is current to the end of 2014. We included patients younger than 65 years at the time of diagnosis of MM as first malignant neoplasm to focus the analysis in patients more likely to receive AHCT and presumably prolonged lenalidomide exposure. For each cohort, we calculated the incidence of SMN considering death from any cause as a competing risk. Since comparison by era is subject to confounding by attained age, we analyzed and compared standardized incidence ratios (SIRs) for SMN and causes of death (COD) in intervals of 5 years: years 1-5 and years 6-10 from diagnosis. Results: There were 2,720 patients in the 1995-1999, 3,246 in the 2000-2004 and 3,867 in the 2005-2009 cohort. Median age of diagnosis was 56 years and 56.6% of the patients were males with no differences across cohorts. Non-Hispanic Whites were 55.9%, non-Hispanic Blacks 23.2%, Hispanics 12.6% and individuals of other race/ethnicities 8.2%. Median follow up of survivors was 198 months (range 1-239), 141 months (range 1-179) and 81 months (range 0-119) in the 1995-1999, 2000-2004 and 2005-2009 cohorts respectively. Cumulative incidences of SMN at 90 months were 4.7% (95% C.I. 4.0-5.6%), 6.0% (95% C.I. 5.2%-6.8%) and 6.3% (95% C.I. 5.5%-7.1%), respectively in the 3 consecutive cohorts, P=0.0008. The statistically significant, yet small increase in SMN is accompanied with decline in all-cause mortality in the same period from 69.9% for the 1995-1999 cohort to 60.4% for the 2000-2004 cohort to 52.8% for the 2005-2009 cohort, P<0.0001. During years 1-5 after MM diagnosis, the risk of another cancer of any type evolved from lower than expected in an age, gender and race-matched population for patients diagnosed in 1995-1999 (SIR=0.77, 95% C.I. 0.59-0.99) to similar to expected for patients diagnosed in 2005-2009 (SIR=1.15, 95% C.I. 0.97-1.36), driven particularly by increase in hematologic malignancies from SIR=1.28 (95% C.I. 0.47-2.78) to SIR=2.17 (95% C.I. 1.27-3.48),(Figure). For years 6-10, the overall risk of subsequent malignancy in MM survivors is similar to the matched population for both the 1995-1999 and the 2000-2004 cohorts (most recent cohort with 10-year follow up). However, the risk of subsequent hematologic malignancy is increased in both periods with the most substantial change being in the risk of lymphomas evolving from SIR=0.59 (95% C.I. 0.01-3.29) for the 1995-1999 cohort to SIR=3.31 (95% C.I. 1.51-6.27) for the 2000-2004 cohort. As expected, overall mortality in years 1-5 declined sharply across the three cohorts (Table), driven by decline in both MM-associated (from 159.4 to 91.7/1,000 patient-year) and cardiovascular mortality (from 12.6 to 9.1/1,000 patient-year). Importantly, there was no discernible increase in risk of death from SMN (from 4.5 to 3.9/1,000 patient-year). Conclusions: This population study confirms that the evolution of MM therapy in the US in the last 20 years is associated with a small, statistically significant increase in the risk of SMN in patients <65 years. Such increase is driven mostly by the increased incidence of hematologic malignancies. The study also demonstrates that the mortality from SMN is modest, has not significantly increased over time and is obscured by the robust reduction in mortality from MM. Disclosures No relevant conflicts of interest to declare.

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Second Malignant Neoplasms in Patients with Rhabdomyosarcoma: A US Population-Based Analysis

10.21203/rs.3.rs-639505/v1 ◽

2021 ◽

Author(s):

HONGNAN ZHEN ◽

ZHIKAI LIU ◽

HUI GUAN ◽

JIABIN MA ◽

WENHUI WANG ◽

...

Keyword(s):

Risk Factors ◽

Soft Tissues ◽

Survival Rates ◽

Malignant Neoplasm ◽

The United States ◽

Population Based ◽

Malignant Neoplasms ◽

Second Malignant Neoplasm ◽

Second Malignant Neoplasms ◽

Risk Patients

Abstract Objective Rhabdomyosarcoma (RMS) is a rare malignant tumor. The main treatment modality is comprehensive with chemotherapy, radiation therapy, and surgery. With the advancement in recent decades, patient survival has been prolonged, and long-term complications are attracting increasing attention among both physicians and patients. This study aimed to present the survival of patients with RMS and analyze the risk factors for the development of a second malignant neoplasm (SMN). Methods The Surveillance, Epidemiology, and End Results (SEER) Program 18 registry database from 1973 to 2015 of the National Cancer Institute of the United States was used for the survival analyses, and the SEER 9 for the SMN analysis. Results The 5-, 10-, and 20-year overall survival rates of the patients with RMS were 45%, 43%, and 33%, respectively. The risk of SMN was significantly higher in patients with RMS compared to the general population (SIR = 1.95, 95% CI: 1.44–2.57, p < 0.001). The risk of developing SMN was increased in multiple locations, including the bones and joint (SIR = 35.25) and soft tissues including the heart (SIR = 22.5), breasts (SIR = 2.10), male genital organs (SIR = 118.14), urinary system (SIR = 2.36), brain (SIR = 9.21), and brain and other nervous system organs (SIR = 8.59). The multivariate analysis indicated that RMS in the limbs and earlier diagnosis time were independent risk factors for the development of SMN. Patients with head and neck (OR = 0.546, 95% CI: 0.313–0.952, p = 0.033) and trunk RMS (OR = 0.322, 95% CI: 0.184–0.564. p < 0.001) and a later diagnosis time were less likely to develop SMN (OR = 0.496, 95% CI: 0.421–0.585, p < 0.001). Conclusion This study describes the risk factors associated with the development of SMN in patients with RMS, which is helpful for the personalized screening of high-risk patients with RMS.

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Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

European Heart Journal ◽

10.1093/ehjci/ehaa946.3251 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Caro Codon ◽

T Lopez-Fernandez ◽

C Alvarez-Ortega ◽

P Zamora Aunon ◽

I Rodriguez Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cancer Therapy ◽

Cancer Patients ◽

Individual Risk ◽

Funding Source ◽

Number Of Patients ◽

All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

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Risk of developing second malignant neoplasms in patients with neuroblastoma: a population study of the US SEER database

Radiation Oncology ◽

10.1186/s13014-021-01943-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hongnan Zhen ◽

Hui Guan ◽

Jiabin Ma ◽

Wenhui Wang ◽

Shen Jing ◽

...

Keyword(s):

Risk Factor ◽

Digestive System ◽

Survival Rates ◽

Endocrine System ◽

Malignant Neoplasms ◽

Seer Database ◽

The Us ◽

Second Malignant Neoplasms ◽

Risk Patients

Abstract Background Neuroblastoma is a common extracranial malignant tumor in children. Its main treatment modality is a combination of chemotherapy, radiotherapy, and surgery. Given the advances in chemotherapy regimens and the widespread use of bone marrow transplantation over the decades, there has been improvement in treatment efficacy, which has led to prolonged patient survival. Accordingly, long-term complications have become a growing concern among physicians and patients. This study aimed to analyze the survival rate of patients with neuroblastoma and the risk factors for developing second malignant neoplasms (SMNs). Methods The SEER 18 Regs (1973–2015) and SEER 9 Regs (1973–2015) data of the surveillance, epidemiology, and end results (SEER) database of the US National Cancer Institute were adopted for survival and SMN analysis. Results The 5-, 10-, and 20-year overall survival rates of patients with neuroblastoma were 67%, 65%, and 62%, respectively. Among 38 patients with neuroblastoma who presented with SMNs, those with abdomen as the primary site accounted for the majority (63.2%), followed by those with thorax (26.3%) and other sites (10.5%). SMNs occurred more commonly in non-specific neuroblastoma (incidence: 0.87%) than ganglioneuroblastoma (incidence: 0.3%). Compared with the general population, the risk of SMN is significantly higher (SIR = 4.36). The risk of developing SMNs was significantly higher in the digestive system (SIR = 7.29), bones and joints (SIR = 12.91), urinary system (SIR = 23.48), brain and other nervous systems (SIR = 5.70), and endocrine system (SIR = 5.84). Multivariate analysis revealed that the year of diagnosis (OR = 2.138, 95% CI = 1.634–2.797, p < 0.001) was the only independent risk factor for developing SMNs. Conclusion This study identifies the risk factor for developing SMNs in patients with neuroblastoma, which could facilitate individualized screening for high-risk patients, to allow early diagnosis and treatment of SMNs.

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Nutrition and Dietary Habits Associated with Risk of Colorectal Cancer in the Population of Omsk region: Case-Control Study

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2019-18-1-67-73 ◽

2019 ◽

Vol 18 (1) ◽

pp. 67-73

Author(s):

N. G. Shirlina ◽

V. L. Stasenko ◽

D. V. Turchaninov ◽

I. A. Sohoshko

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Food Habits ◽

Dietary Habits ◽

Eating Habits ◽

Case Control ◽

Red Meat ◽

Biological Factor ◽

Individual Risk ◽

Malignant Neoplasms

Relevance.Nutrition is the most important biological factor on which the functioning of the human body depends. The link between the development of colorectal cancer and nutrition and eating habits is well known: excessive consumption of red meat, fats, alcohol, lack of dietary fiber, obesity. Objective: To assess the prevalence and significance of factors related to nutrition and food habits in the development of colorectal cancer (CRC) in the population of the Omsk region.Materials and methods.An epidemiological analytical study (case-control) was conducted, in which 609 people took part - residents of the Omsk Region aged 30 to 85 years (average age 51.2 years; 95% CI 48.1 – 54.3). The study examined 23 factors characterizing the diet and eating habits of study participants.Result and discussion.Of the 23 risk factors for CRC associated with nutrition and food habits, only six confirmed their importance to the residents of the Omsk region: a body mass index of more than 25, alcohol consumption more than twice a month with a predominance of strong, the frequency of red meat consumed more than 10 times a month, the amount of fresh fruit consumed is less than 100 grams at a time, the preference for fatty foods.Findings.The implementation of preventive measures, taking into account the prevalence of risk factors for CRC, including factors related to nutrition and eating habits, reduces the population and individual risk of this pathology in the population of the region, as well as health losses due to malignant neoplasms of the colon and colon.

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Discriminating uninfected surgical bed cysts from bacterial brain abscesses after Carmustine wafer implantation in newly diagnosed IDH-wildtype glioblastomas

10.21203/rs.3.rs-543549/v1 ◽

2021 ◽

Author(s):

Alexandre Roux ◽

Hichem Ammar ◽

Alessandro Moiraghi ◽

Sophie Peeters ◽

Marwan Baroud ◽

...

Keyword(s):

Risk Factors ◽

Mass Effect ◽

Cyst Formation ◽

Individual Risk ◽

Newly Diagnosed ◽

Postoperative Mri ◽

Carmustine Wafer ◽

Brain Abscesses ◽

Individual Risk Factors

Abstract PurposeCarmustine wafers can be implanted in the surgical bed of high-grade gliomas, which can induce surgical bed cyst formation, leading to clinically relevant mass effect.MethodsAn observational retrospective monocentric study was conducted including 122 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent a surgical resection with Carmustine wafer implantation as first line treatment (2005–2018).FindingsTwenty-two patients (18.0%) developed a postoperative contrast-enhancing cyst within the surgical bed: 16 uninfected cysts and six bacterial abscesses. All patients with an uninfected surgical bed cyst were managed conservatively, all resolved on imaging follow-up, and no patient stopped the radiochemotherapy. Independent risk factors of formation of a postoperative uninfected surgical bed cyst were age ≥ 60 years (p = 0.019), number of Carmustine wafers implanted ≥ 8 (p = 0.040), and partial resection (p = 0.025). Compared to uninfected surgical bed cysts, the occurrence of a postoperative bacterial abscess requiring surgical management was associated more frequently with a shorter time to diagnosis from surgery (p = 0.009), new neurological deficit (p < 0.001), fever (p < 0.001), residual air in the cyst (p = 0.018), a cyst diameter greater than that of the initial tumor (p = 0.027), and increased mass effect and brain edema compared to early postoperative MRI (p = 0.024). Contrast enhancement (p = 0.473) and diffusion signal abnormalities (p = 0.471) did not differ between postoperative bacterial abscesses and uninfected surgical bed cysts.ConclusionsClinical and imaging findings help discriminate between uninfected surgical bed cysts and bacterial abscesses following Carmustine wafer implantation. Surgical bed cysts can be managed conservatively. Individual risk factors will help tailor their steroid therapy and imaging follow-up.

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Second malignant neoplasms in children: an update from the Late Effects Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.4.532 ◽

1985 ◽

Vol 3 (4) ◽

pp. 532-538 ◽

Cited By ~ 357

Author(s):

A T Meadows ◽

E Baum ◽

F Fossati-Bellani ◽

D Green ◽

R D Jenkin ◽

...

Keyword(s):

Risk Factors ◽

Late Effects ◽

Wilms Tumor ◽

Soft Tissue Sarcomas ◽

Malignant Neoplasms ◽

Study Group ◽

Second Malignant Neoplasms ◽

Bone Sarcomas ◽

Radiation Genetic ◽

Survivors Of Childhood Cancer

This paper presents an update from the Late Effects Study Group on 292 cases of second malignant neoplasms (SMN) occurring in individuals who were diagnosed with their first neoplasm in childhood. Data are presented regarding the types of first and second neoplasm, the therapy administered, and the predisposing factors. Of the 292 cases (308 SMN), the most common primary was retinoblastoma followed by Hodgkin's disease, soft-tissue sarcomas, and Wilms' tumor. This is not similar to the relative frequency of these cancers in children but rather reflects specific risk factors. Bone sarcomas were the most common SMN among the 208 SMN developing in previously irradiated sites while acute leukemia was the most common SMN unassociated with radiation. Known predisposing conditions to cancer were present in 73 cases; retinoblastoma was the most common of these, followed by neurofibromatosis. There were ten patients with three and three patients with four malignant neoplasms. In 14 patients, the cause of SMN was not suggested by known risk factors as these patients had negative family histories and received no radiation or chemotherapy. We note, therefore, that although most cases of SMN in survivors of childhood cancer can be attributed to radiation, genetic disease, chemotherapy, or combinations of these, unrecognized predisposition or chance may also play a role.

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Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial

The International Journal of Neuropsychopharmacology ◽

10.1017/s1461145712001241 ◽

2013 ◽

Vol 16 (5) ◽

pp. 987-995 ◽

Cited By ~ 47

Author(s):

W. Wolfgang Fleischhacker ◽

Cynthia O. Siu ◽

Robert Bodén ◽

Elizabeth Pappadopulos ◽

Onur N. Karayal ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Prevalence Rate ◽

Individual Risk ◽

First Episode ◽

Antipsychotic Treatment ◽

Treatment Groups ◽

Individual Risk Factors ◽

First Episode Schizophrenia

Abstract Available data on antipsychotic-induced metabolic risks are often constrained by potential confounding effects due to prior antipsychotic treatment. In this study, we assessed the baseline prevalence of metabolic abnormalities and changes following treatment with five commonly-used antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine or ziprasidone) in first-episode, partially antipsychotic-naive patients with schizophrenia in the European first-episode schizophrenia trial (EUFEST). Overall baseline prevalence of metabolic syndrome (MetS) was 6.0%, with similar rates observed in the antipsychotic-naive patients (5.7%, 9/157) and in the other patients with only a brief prior exposure to antipsychotics (6.1%, 20/326). These results are consistent with the MetS prevalence rate estimated in a general population of similar age. Examination of individual risk factors showed 58.5% of subjects had one or more elevated metabolic risks at baseline: 28.5% demonstrated suboptimal HDL; 24.2% hypertension; 17.7% hypertriglyceridemia; 8.2% abdominal obesity; 7.3% hyperglycaemia. Increase in body weight (kg/month) occurred in patients treated with haloperidol (0.62 s.e. 0.11), amisulpride (0.76 s.e. 0.08), olanzapine (0.98 s.e. 0.07) and quetiapine (0.58 s.e. 0.09), which was significantly greater than that in the ziprasidone group (0.18 s.e. 0.10). The incidence rate of new diabetes cases over a 52-wk follow-up period was 0.82% (4/488). More patients experienced worsening rather than improvement of hypertriglyceridemia or hyperglycaemia in all treatment groups. Our findings suggest that in first-episode, partially antipsychotic-naive patients, the baseline prevalence rate of MetS appears to be no higher than that in the general population, but serious underlying individual risk factors nevertheless existed.

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