Incidence and risk factors for secondary malignancy in patients with neuroblastoma after treatment with 131I-metaiodobenzylguanidine

Publication date: October 2016
Source:European Journal of Cancer, Volume 66
Author(s): Kelly E. Huibregtse, Kieuhoa T. Vo, Steven G. DuBois, Stephanie Fetzko, John Neuhaus, Vandana Batra, John M. Maris, Brian Weiss, Araz Marachelian, Greg A. Yanik, Katherine K. Matthay
Several reports of second malignant neoplasm (SMN) in patients with relapsed neuroblastoma after treatment with ¹³¹I-MIBG suggest the possibility of increased risk. Incidence of and risk factors for SMN after ¹³¹I-MIBG have not been defined.This is a multi-institutional retrospective review of patients with neuroblastoma treated with ¹³¹I-MIBG therapy. A competing risk approach was used to calculate the cumulative incidence of SMN from time of first exposure to ¹³¹I-MIBG. A competing risk regression was used to identify potential risk factors for SMN.The analytical cohort included 644 patients treated with ¹³¹I-MIBG. The cumulative incidence of SMN was 7.6% (95% confidence interval [CI], 4.4–13.0%) and 14.3% (95% CI, 8.3–23.9%) at 5 and 10 years from first ¹³¹I-MIBG, respectively. No increase in SMN risk was found with increased number of ¹³¹I-MIBG treatments or higher cumulative activity per kilogram of ¹³¹I-MIBG received (p = 0.72 and p = 0.84, respectively). Thirteen of the 19 reported SMN were haematologic. In a multivariate analysis controlling for variables with p < 0.1 (stage, age at first ¹³¹I-MIBG, bone disease, disease status at time of first ¹³¹I-MIBG), patients with relapsed/progressive disease had significantly lower risk of SMN (subdistribution hazard ratio 0.3, 95% CI, 0.1–0.8, p = 0.023) compared to patients with persistent/refractory neuroblastoma.The cumulative risk of SMN after ¹³¹I-MIBG therapy for patients with relapsed or refractory neuroblastoma is similar to the greatest published incidence for high-risk neuroblastoma after myeloablative therapy, with no dose-dependent increase. As the number of patients treated and length of follow-up time increase, it will be important to reassess this risk.



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