Risk of subsequent primary leukaemias among 69,460 five-year survivors of childhood cancer diagnosed from 1940 to 2008 in Europe: a cohort study within PanCareSurFup

Rodrigue S Allodji, Mike M Hawkins, Chloe J Bright, Miranda M Fidler-Benaoudia, David L Winter, Daniela Alessi, Brice Fresneau, Neige Journy, Vera Morsellino, Edit Bárdi, Andrea Bautz, Julianne Byrne, Elizabeth Lieke Am Feijen, Jop C Teepen, Giao Vu-Bezin, Carole Rubino, Stanislaw Garwicz, Desiree Grabow, Thorgerdur Gudmundsdottir, Joyeeta GuhaEva-Maria Hau, Momcilo Jankovic, Peter Kaatsch, Melanie Kaiser, Helena Linge, Monica Muraca, Damien Llanas, Cristina Veres, Hilde Øfstaas, Ibrahima Diallo, Imene Mansouri, Cecile M Ronckers, Roderick Skinner, Monica Terenziani, Finn Wesenberg, Thomas Wiebe, Carlotta Sacerdote, Zsuzsanna Jakab, Riccardo Haupt, Päivi Lähteenmäki, Lorna Zadravec Zaletel, Claudia E Kuehni, Jeanette F Winther, Gisela Michel, Leontien C M Kremer, Lars Hjorth, Nadia Haddy, Florent de Vathaire, Raoul C Reulen

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BACKGROUND: Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors.

METHODS: This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated.

RESULTS: One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs.

CONCLUSIONS: We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.

Original languageEnglish
Pages (from-to)71-83
Number of pages13
JournalEuropean Journal of Cancer
Early online date28 Jun 2019
Publication statusPublished - Aug 2019

Bibliographical note

Copyright © 2019 Elsevier Ltd. All rights reserved.


  • Childhood cancer survivors
  • Second cancers
  • Subsequent primary leukaemia
  • Myeloid leukaemias
  • Lymphoid leukaemias


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