{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:13Z","timestamp":1760144713475,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,11]],"date-time":"2024-05-11T00:00:00Z","timestamp":1715385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"F\u00f6rderkreis krebskranke Kinder e. V. Stuttgart"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose: Osteosarcoma may arise as a secondary cancer following leukemias or lymphomas. We intended to increase the knowledge about such rare events. Patients and methods: We searched the Cooperative Osteosarcoma Study Group\u2019s database for individuals who developed their osteosarcoma following a previous hematological malignancy. The presentation and treatment of both malignancies was investigated, and additional neoplasms were noted. Outcomes after osteosarcoma were analyzed and potential prognostic factors were searched for. Results: A total of 33 eligible patients were identified (male: 23, female: 10; median age: 12.9 years at diagnosis of hematological cancer; 20 lymphomas, 13 leukemias). A cancer predisposition syndrome was evident in one patient only. The hematological cancers had been treated by radiotherapy in 28 (1 unknown) and chemotherapy in 26 cases, including bone-marrow transplantation in 9. The secondary bone sarcomas (high-grade central 27, periosteal 2, extra-osseous 2, undifferentiated pleomorphic sarcoma of bone 2) arose after a median lag-time of 9.4 years, when patients were a median of 19.1 years old. Tumors were considered radiation-related in 26 cases (1 unknown). Osteosarcoma-sites were in the extremities (19), trunk (12), or head and neck (2). Metastases at diagnosis affected eight patients. Information on osteosarcoma therapy was available for 31 cases. All of these received chemotherapy. Local therapy involved surgery in 27 patients, with a good response reported for 9\/18 eligible patients. Local radiotherapy was given to three patients. The median follow-up was 3.9 (0.3\u201312.0) years after bone tumor diagnosis. During this period, 21 patients had developed events as defined, and 15 had died, resulting in 5-year event-free and overall survival rates of 40% (standard error: 9%) and 56% (10%), respectively. There were multiple instances of additional neoplasms. Several factors were found to be of prognostic value (p &lt; 0.05) for event-free (osteosarcoma site in the extremities) or overall (achievement of a surgical osteosarcoma-remission, receiving chemotherapy for the hematologic malignancy) survival. Conclusions: We were able to prove radiation therapy for hematological malignancies to be the predominant risk factor for later osteosarcomas. A resulting overrepresentation of axial and a tendency towards additional neoplasms affects prognosis. Still, selected patients may become long-term survivors with appropriate therapies, which is an argument against therapeutic negligence.<\/jats:p>","DOI":"10.3390\/cancers16101836","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T08:33:03Z","timestamp":1715589183000},"page":"1836","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Osteosarcoma Arising as a Secondary Malignancy following Treatment for Hematologic Cancer: A Report of 33 Affected Patients from the Cooperative Osteosarcoma Study Group (COSS)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2144-3153","authenticated-orcid":false,"given":"Stefan S.","family":"Bielack","sequence":"first","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"},{"name":"Klinik f\u00fcr Kinder- und Jugendmedizin, P\u00e4diatrische H\u00e4matologie und Onkologie, Universit\u00e4tsklinikum M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Mettmann","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Baumhoer","sequence":"additional","affiliation":[{"name":"Knochentumor Referenzzentrum, Institut f\u00fcr Medizinische Genetik und Pathologie, Universit\u00e4tsspital und Universit\u00e4t Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Blattmann","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-829X","authenticated-orcid":false,"given":"Birgit","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kinder- und Jugendmedizin, P\u00e4diatrische H\u00e4matologie und Onkologie, Universit\u00e4tsklinikum M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1961-9382","authenticated-orcid":false,"given":"Christoph K. W.","family":"Deinzer","sequence":"additional","affiliation":[{"name":"Abteilung Innere Medizin VIII\u2014Medizinische Onkologie und Pneumologie, Universit\u00e4tsklinikum T\u00fcbingen, 72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-6488","authenticated-orcid":false,"given":"Leo","family":"Kager","sequence":"additional","affiliation":[{"name":"St. Anna Kinderspital, Universit\u00e4tsklinik f\u00fcr Kinder- und Jugendheilkunde der Medizinischen Universit\u00e4t Wien, 1090 Vienna, Austria"},{"name":"St. Anna Children\u2019s Cancer Research Institute (CCRI), 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Kevric","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8205-8665","authenticated-orcid":false,"given":"Christine","family":"Mauz-K\u00f6rholz","sequence":"additional","affiliation":[{"name":"P\u00e4diatrische H\u00e4matologie und Onkologie, Zentrum f\u00fcr Kinderheilkunde der Justus-Liebig-Universit\u00e4t, 35390 Gie\u00dfen, Germany"},{"name":"Medizinische Fakult\u00e4t der Martin-Luther-Universit\u00e4t Halle-Wittenberg, 06120 Halle, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"M\u00fcller-Abt","sequence":"additional","affiliation":[{"name":"Radiologisches Institut (Kinderradiologie), Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart\u2014Olgahospital, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-4483","authenticated-orcid":false,"given":"Dirk","family":"Reinhardt","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kinderheilkunde III, Zentrum f\u00fcr Kinder- und Jugendmedizin, Universit\u00e4tsmedizin Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3632-7520","authenticated-orcid":false,"given":"Alexandru-Anton","family":"Sabo","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Schrappe","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kinder- und Jugendmedizin I, Campus Kiel, Universit\u00e4tsklinikum Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Sorg","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhard","family":"Windhager","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinik f\u00fcr Orthop\u00e4die und Unfallchirurgie, Klinische Abteilung f\u00fcr Orthop\u00e4die, Medizinische Universit\u00e4t Wien, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanie","family":"Hecker-Nolting","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart\u2014Olgahospital, Stuttgart Cancer Center, Zentrum f\u00fcr Kinder-, Jugend- und Frauenmedizin, P\u00e4diatrie 5 (Onkologie, H\u00e4matologie, Immunologie), 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2938","DOI":"10.1200\/JCO.2014.59.1636","article-title":"Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration","volume":"33","author":"Pui","year":"2015","journal-title":"J. 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