Meta-analysis of secondary hematologic malignancy risks following radioactive iodine therapy for differentiated thyroid cancer

source extracted confidence: high 2026-04-09
#humans #thyroid-neoplasms #iodine-radioisotopes #hematologic-neoplasms #neoplasms-second-primary

Meta-analysis of secondary hematologic malignancy risks following radioactive iodine therapy for differentiated thyroid cancer

Su et al., 2025 | Int J Surg | Meta Analysis

Citation

Su Hongyue, Yang Fan, ... Sun Wei. Meta-analysis of secondary hematologic malignancy risks following radioactive iodine therapy for differentiated thyroid cancer. Int J Surg. 2025-Oct-01;111(10):7312-7321. doi:10.1097/JS9.0000000000002813

Abstract

PURPOSE: Radioactive iodine (RAI) therapy remains a widely accepted and effective intervention for differentiated thyroid cancer (DTC). Nonetheless, concerns persist regarding the potential emergence of second primary malignancies following RAI exposure. To assess the association between RAI administration and the risk of secondary hematologic malignancies in DTC patients, a meta-analysis was conducted. METHODS: A systematic literature search was performed via PubMed and Web of Science, conforming to PRISMA guidelines. RESULTS: Seventeen studies, including a total of 586 260 DTC patients, were included in the final analysis. The aggregated risk ratio (RR) for secondary hematologic malignancies among those treated with RAI was 1.25 (95% CI: 1.13-1.38, P< 0.0001), compared with non-RAI recipients. Heterogeneity across studies was minimal ( I2  = 8%). Further subgroup analyses were conducted based on malignancy subtype and RAI dosage. The RR estimates by subtype were as follows: non-Hodgkin's lymphoma, 0.91 (95% CI: 0.72-1.16, P = 0.45); Hodgkin's lymphoma, 1.17 (95% CI: 0.62-2.21, P = 0.63); myeloma, 0.90 (95% CI: 0.59-1.37, P = 0.62); and leukemia, 1.52 (95% CI: 1.05-2.21, P = 0.03). For patients receiving RAI doses below 3.7 GBq, the pooled RR was 0.39 (95% CI: 0.22-0.72, P = 0.002). Sensitivity and subgroup analyses reinforced the robustness and internal consistency of these findings. No publication bias was detected via Egger's regression or Begg's funnel plot ( P =  0.511). CONCLUSION: These results suggest a potential elevation in the risk of secondary hematologic malignancies - particularly leukemia - following RAI therapy in DTC patients. However, administration of RAI at doses below 3.7 GBq may not confer such risk. Additional large-scale, multicenter prospective investigations are warranted to validate these observations.

Key Findings

Seventeen studies, including a total of 586 260 DTC patients, were included in the final analysis. The aggregated risk ratio (RR) for secondary hematologic malignancies among those treated with RAI was 1.25 (95% CI: 1.13-1.38, P< 0.0001), compared with non-RAI recipients. Heterogeneity across studies was minimal ( I2  = 8%). Further subgroup analyses were conducted based on malignancy subtype and RAI dosage. The RR estimates by subtype were as follows: non-Hodgkin's lymphoma, 0.91 (95% CI: 0.72-

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Thyroid Neoplasms
  • Iodine Radioisotopes
  • Hematologic Neoplasms
  • Neoplasms, Second Primary
  • Neoplasms, Radiation-Induced

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: iodine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09