Retrospective cohort study of long-term risk of subsequent neoplasms in 5-year survivors of childhood neuroblastoma

Neuroblastoma survivors are at increased risk of developing subsequent malignant neoplasms (SMNs), but the risk of subsequent nonmalignant neoplasms (SNMNs) and risk factors are largely unknown. The DCCS-LATER 3 cohort study in The Netherlands included 563 5-year neuroblastoma survivors, diagnosed during 1963-2014. In total, 23 survivors developed a SMN and 60 a SNMN. During median follow-up of 23.7 years (range 5.0-56.3) the risk of SMN was elevated compared with the general population (SIR 4.0; 95% CI 2.5-5.9). The 30-year cumulative incidence was 3.4% (95% CI 1.9-6.0) for SMNs and 10.4% (7.3-14.8) for SNMNs. Survivors treated with ¹³¹I-metaiodobenzylguanidine (MIBG) were at higher risk of SMNs (sHR 5.7; 95% CI 1.8-17.8) and SNMNs (2.6; 1.2-5.6) than survivors not treated with ¹³¹I-MIBG. The authors conclude that survivors of neuroblastoma are at elevated risk of SMNs and SNMNs, and that ¹³¹I-MIBG treatment may be a risk factor for development of SMNs and SNMNs.