Risk of central nervous system tumors in long-term survivors of childhood ALL or AML

This study examined the risk of developing central nervous system (CNS) tumors in childhood leukemia patients who underwent allogeneic (from a matched donor) stem cell transplantation. This study concluded that childhood leukemia patients have an increased risk of later developing CNS tumors.

Improvements in treatments and care have increased survival for childhood leukemia patients. However, long-term survivors may be at risk for complications later in life. The risk of other cancers, for example, is higher compared to the general population. Radiation therapy directed at the brain in childhood acute lymphoblastic leukemia (ALL) has been associated with an increased risk of CNS tumors.

Another common treatment option for childhood leukemia is an allogeneic stem cell transplant (allo-SCT). Some studies have noted an increased risk for other cancers later in life following this treatment. However, further studies are needed.

The current study examined the rate and risk factors associated with developing a CNS tumor later in life following allo-SCT. The records of 8,720 patients were reviewed. All patients had undergone allo-SCT in childhood (between the years of 1976 and 2008). 45% of patients had childhood ALL. 30% of patients had childhood acute myeloid leukemia (AML).

59 patients later developed a CNS tumor. Of these, 75% of these patients had childhood ALL. 14% had childhood AML. 53% had received stem cells from an unrelated donor. 31% had had CNS involvement during childhood. 34% had received radiation to the head area. CNS involvement during childhood was associated with an 8.21 higher risk of later developing a CNS tumor.

Women were 74% less likely to develop a CNS tumor than men. Patients who had chronic graft-versus-host disease (a condition where the transplanted stem cells begin attacking healthy tissue) had a 71% decreased risk.

This study concluded that survivors of childhood ALL or AML who underwent allo-SCT have an increased risk of developing CNS tumors. 

There were a small number of cases of CNS tumors found over the 32-year time period studied. 

Discuss with your doctor whether or not you should be monitored for CNS tumors.