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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.
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.
Shares Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast, Thyroid cancer after neck radiotherapy, and whether to look for it, Age, smoking and inherited predisposition: what the treatment risk is added to, Skin cancer after cancer treatment.
Shares Bladder cancer after cyclophosphamide, Thyroid cancer after neck radiotherapy, and whether to look for it, Skin cancer after cancer treatment, The UK very high risk breast screening protocol after chest radiotherapy.
Shares Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, After Hodgkin lymphoma: the late effects, and the screening that follows them, Anthracyclines (doxorubicin, epirubicin), Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them.
Shares Survival after transplant, and why the curve never quite rejoins the population, Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast, Bladder cancer after cyclophosphamide, From a clone in the blood to a leukaemia: what is known, and what is done.
Shares Long-term follow-up for gene-modified cell products: fifteen years, and why, Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says, Second cancers after allogeneic transplant, Platinum drugs and PARP inhibitors: the newer leukaemia risk.
Shares Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says, From a clone in the blood to a leukaemia: what is known, and what is done, Second cancers after allogeneic transplant, Alkylating agents and therapy-related myeloid neoplasms.
Shares Long-term follow-up for gene-modified cell products: fifteen years, and why, Survival after transplant, and why the curve never quite rejoins the population, Second cancers after allogeneic transplant, Late effects after a stem cell transplant.
Shares Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Relapsed and refractory classical Hodgkin lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II).