Turcotte LM, Liu Q, Yasui Y, et al. - Chemotherapy-associated subsequent malignant neoplasm (SMN) risk has been assessed via evaluating SMNs occurring > 5 years from diagnosis, excluding nonmelanoma skin cancers, in survivors diagnosed when they were < 21 years old, from 1970 to 1999 in the Childhood Cancer Survivor Study (median age at diagnosis, 7.0 years; median age at last follow-up, 31.8 years). Researchers estimated 30-year SMN cumulative incidence and standardized incidence ratios (SIRs) by treatment: chemotherapy-only (n = 7,448), chemotherapy plus radiation (n = 10,485), radiation only (n = 2,063), or neither (n = 2,158). They identified 1,498 SMNs among 1,344 survivors; Of these, 229 developed in 206 survivors treated with chemotherapy only. The analysis revealed an increased SMN risk among childhood cancer survivors who received chemotherapy only, particularly higher cumulative doses of platinum and alkylating agents. They observed linear dose responses between alkylating agents and SMN rates and between anthracyclines and breast cancer rates. Reduction in SMN risk could be achieved via limiting cumulative doses and considering alternate chemotherapies.