{"entity":{"id":"secondary-malignancy","kind":"term","name":"Secondary malignancy (therapy-related cancer)","aka":["secondary malignancies","second malignancy","second malignancies","second cancer","second cancers","second primary","second primary cancer","second primary cancers","second primary malignancy","therapy-related","treatment-related cancer","treatment-induced cancer","therapy-related AML","therapy-related MDS","therapy-related myeloid neoplasm","t-MN","t-AML","radiation-induced","radiation-induced cancer","radiation-induced sarcoma","secondary leukaemia","secondary leukemia","secondary AML","T-cell lymphoma after CAR-T","T-cell malignancies","second primaries","second primary malignancies","T-cell malignancy","therapy-related myeloid neoplasms"],"tldr":"A new, different cancer caused by the treatment of the first one: leukaemia after alkylating chemotherapy or PARP inhibitors, solid tumours in irradiated tissue decades later, and rarely T-cell lymphoma after CAR-T. Rare per patient, but it matters most for those cured young.","summary":"Therapy-related myeloid neoplasms (MDS/AML) follow alkylators (5-7 years, often with TP53 mutations and complex karyotype), topoisomerase II inhibitors (2-3 years, MLL rearrangements), PARP inhibitors (about 1-2% in maintenance trials), lenalidomide maintenance and radiotherapy, and carry shorter survival than de novo disease; they often arise from pre-existing clonal haematopoiesis. Radiation-induced solid cancers (breast cancer after Hodgkin mantle radiotherapy, sarcomas, thyroid cancer after childhood radiation) appear 10-30 years later and drive the search for less radiation in curable young patients. Secondary T-cell malignancies after CAR-T (FDA boxed warning, 2024) are rare and mostly unrelated to insertional mutagenesis. Second primary cancers also reflect shared risk factors (tobacco in head and neck and lung cancer) and genetic syndromes.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Secondary_malignant_neoplasm","links":[{"label":"NCI Dictionary of Cancer Terms: secondary cancer","url":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/secondary-cancer"},{"label":"Schaapveld et al., second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, New England Journal of Medicine 2015 (3,905 Dutch survivors)","url":"https://doi.org/10.1056/NEJMoa1505949"},{"label":"GOV.UK: protocols for surveillance of women at higher risk of developing breast cancer, NHS Breast Screening Programme","url":"https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/protocols-for-surveillance-of-women-at-higher-risk-of-developing-breast-cancer"},{"label":"Lymphoma Action: annual breast screening missed following radiotherapy for Hodgkin lymphoma","url":"https://lymphoma-action.org.uk/news/annual-breast-screening-missed-following-radiotherapy-hodgkin-lymphoma"}],"tags":[],"related":["mds","clonal-haematopoiesis","late-effects","alkylating-agent","anthracycline"],"cancers":["hodgkin-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","relapsed-refractory-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","non-hodgkin-lymphoma","dlbcl"],"sections":["supportive-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Hodgkin lymphoma: among 3,905 people in the Netherlands who survived at least five years after treatment given between 1965 and 2000 at ages 15 to 50, 1,055 second cancers occurred in 908 people over a median 19.1 years, a standardised incidence ratio of 4.6 against the general population, still 3.9 at 35 or more years, with a cumulative incidence at 40 years of 48.5 per cent. The authors found the risk of second solid cancers no lower in the most recent period studied. The NHS Breast Screening Programme places women irradiated to breast tissue for lymphoma between the ages of 10 and under 36 in its very high risk group, screened annually and usually with magnetic resonance imaging."],"category":"Side effects"},"route":"/terms/secondary-malignancy/","neighbours":{"cancer":[{"id":"aml-paediatric","kind":"cancer","name":"Acute myeloid leukaemia in children","route":"/cancers/aml-paediatric/"},{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"mds","kind":"cancer","name":"Myelodysplastic syndromes / neoplasms (MDS)","route":"/cancers/mds/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"aml-secondary","kind":"cancer","name":"Secondary and therapy-related acute myeloid leukaemia","route":"/cancers/aml-secondary/"},{"id":"medulloblastoma-shh","kind":"cancer","name":"SHH-activated medulloblastoma","route":"/cancers/medulloblastoma-shh/"}],"pathway":[{"id":"clonal-haematopoiesis","kind":"pathway","name":"Clonal haematopoiesis (CHIP)","route":"/pathways/clonal-haematopoiesis/"}],"term":[{"id":"abvd-beacopp","kind":"term","name":"ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)","route":"/terms/abvd-beacopp/"},{"id":"lymphoma-living-hodgkin-survivorship-screening","kind":"term","name":"After Hodgkin lymphoma: the late effects, and the screening that follows them","route":"/terms/lymphoma-living-hodgkin-survivorship-screening/"},{"id":"rejuv-second-age-smoking-and-inherited-risk","kind":"term","name":"Age, smoking and inherited predisposition: what the treatment risk is added to","route":"/terms/rejuv-second-age-smoking-and-inherited-risk/"},{"id":"alkylating-agent","kind":"term","name":"Alkylating agents and antimetabolites","route":"/terms/alkylating-agent/"},{"id":"rejuv-second-alkylating-agents-and-myeloid-neoplasms","kind":"term","name":"Alkylating agents and therapy-related myeloid neoplasms","route":"/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/"},{"id":"aml-myelodysplasia-related","kind":"term","name":"AML with myelodysplasia-related gene mutations (AML-MR)","route":"/terms/aml-myelodysplasia-related/"},{"id":"anthracycline","kind":"term","name":"Anthracyclines (doxorubicin, epirubicin)","route":"/terms/anthracycline/"},{"id":"second-primary-bladder-after-cyclophosphamide","kind":"term","name":"Bladder cancer after cyclophosphamide","route":"/terms/second-primary-bladder-after-cyclophosphamide/"},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/"},{"id":"second-primary-breast-after-chest-radiotherapy","kind":"term","name":"Breast cancer after chest radiotherapy given young","route":"/terms/second-primary-breast-after-chest-radiotherapy/"},{"id":"rejuv-second-choices-made-at-treatment","kind":"term","name":"Choices made at the time of treatment that change the second cancer risk","route":"/terms/rejuv-second-choices-made-at-treatment/"},{"id":"lymphoma-decision-beacopp-or-abvd","kind":"term","name":"Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed","route":"/terms/lymphoma-decision-beacopp-or-abvd/"},{"id":"rejuv-second-from-clone-to-disease","kind":"term","name":"From a clone in the blood to a leukaemia: what is known, and what is done","route":"/terms/rejuv-second-from-clone-to-disease/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"lymphoma-tx-hodgkin-late-effects","kind":"term","name":"Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them","route":"/terms/lymphoma-tx-hodgkin-late-effects/"},{"id":"second-primary-lung-after-chest-radiotherapy","kind":"term","name":"Lung cancer after chest radiotherapy and after alkylating chemotherapy","route":"/terms/second-primary-lung-after-chest-radiotherapy/"},{"id":"rejuv-second-platinum-and-parp-inhibitors","kind":"term","name":"Platinum drugs and PARP inhibitors: the newer leukaemia risk","route":"/terms/rejuv-second-platinum-and-parp-inhibitors/"},{"id":"rejuv-second-radiotherapy-dose-field-and-age","kind":"term","name":"Radiotherapy and second cancers: field, dose and age at exposure","route":"/terms/rejuv-second-radiotherapy-dose-field-and-age/"},{"id":"second-primary-sarcoma-in-the-treated-field","kind":"term","name":"Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast","route":"/terms/second-primary-sarcoma-in-the-treated-field/"},{"id":"rejuv-second-screening-after-treatment-compared","kind":"term","name":"Screening survivors: where the UK, American and European answers differ","route":"/terms/rejuv-second-screening-after-treatment-compared/"},{"id":"rejuv-second-cancers-overview","kind":"term","name":"Second cancers after treatment: what the risk is, and what is done about it","route":"/terms/rejuv-second-cancers-overview/"},{"id":"second-primary-skin-cancer-after-cancer-treatment","kind":"term","name":"Skin cancer after cancer treatment","route":"/terms/second-primary-skin-cancer-after-cancer-treatment/"},{"id":"rejuv-second-uk-very-high-risk-breast-screening","kind":"term","name":"The UK very high risk breast screening protocol after chest radiotherapy","route":"/terms/rejuv-second-uk-very-high-risk-breast-screening/"},{"id":"second-primary-thyroid-after-neck-radiotherapy","kind":"term","name":"Thyroid cancer after neck radiotherapy, and whether to look for it","route":"/terms/second-primary-thyroid-after-neck-radiotherapy/"},{"id":"rejuv-second-topoisomerase-inhibitors-short-latency","kind":"term","name":"Topoisomerase II inhibitors and the shorter latency","route":"/terms/rejuv-second-topoisomerase-inhibitors-short-latency/"},{"id":"rejuv-second-what-is-not-a-second-cancer","kind":"term","name":"What is not a second cancer: recurrence, metastasis and field cancerisation","route":"/terms/rejuv-second-what-is-not-a-second-cancer/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","route":"/technologies/rejuv-tx-what-to-ask-for/"},{"id":"gvhd-chronic-overview","kind":"technology","name":"Chronic graft-versus-host disease","route":"/technologies/gvhd-chronic-overview/"},{"id":"rejuv-tx-late-effects-overview","kind":"technology","name":"Late effects after a stem cell transplant","route":"/technologies/rejuv-tx-late-effects-overview/"},{"id":"rejuv-tx-gene-modified-follow-up","kind":"technology","name":"Long-term follow-up for gene-modified cell products: fifteen years, and why","route":"/technologies/rejuv-tx-gene-modified-follow-up/"},{"id":"rejuv-tx-second-cancers","kind":"technology","name":"Second cancers after allogeneic transplant","route":"/technologies/rejuv-tx-second-cancers/"},{"id":"rejuv-tx-secondary-t-cell-malignancy","kind":"technology","name":"Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says","route":"/technologies/rejuv-tx-secondary-t-cell-malignancy/"},{"id":"rejuv-tx-survival-after-transplant","kind":"technology","name":"Survival after transplant, and why the curve never quite rejoins the population","route":"/technologies/rejuv-tx-survival-after-transplant/"}],"journal":[{"id":"radiation-and-environmental-biophysics","kind":"journal","name":"Radiation and environmental biophysics","route":"/journals/radiation-and-environmental-biophysics/"}]}}