Second Malignancy Risks After Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia: Differences by Lymphoma Subtype

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD 20892, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 10/2010; 28(33):4935-44. DOI: 10.1200/JCO.2010.29.1112
Source: PubMed


Previous studies have shown increased risks of second malignancies after non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL); however, no earlier investigation has quantified differences in risk of new malignancy by lymphoma subtype.
We evaluated second cancer and leukemia risks among 43,145 1-year survivors of CLL/small lymphocytic lymphoma (SLL), diffuse large B-cell lymphoma (DLBCL), or follicular lymphoma (FL) from 11 Surveillance, Epidemiology, and End Results (SEER) population-based registries during 1992 to 2006.
Among patients without HIV/AIDS-related lymphoma, lung cancer risks were significantly elevated after CLL/SLL and FL but not after DLBCL (standardized incidence ratio [SIR], CLL/SLL = 1.42, FL = 1.28, DLBCL = 1.00; Poisson regression P for difference among subtypes, P(Diff) = .001). A similar pattern was observed for risk of cutaneous melanoma (SIR: CLL/SLL = 1.92, FL = 1.60, DLBCL = 1.06; P(Diff) = .004). Acute nonlymphocytic leukemia risks were significantly elevated after FL and DLBCL, particularly among patients receiving initial chemotherapy, but not after CLL/SLL (SIR: CLL/SLL = 1.13, FL = 5.96, DLBCL = 4.96; P(Diff) < .001). Patients with HIV/AIDS-related lymphoma (n = 932) were predominantly diagnosed with DLBCL and had significantly and substantially elevated risks for second anal cancer (SIR = 120.50) and Kaposi's sarcoma (SIR = 138.90).
Our findings suggest that differing immunologic alterations, treatments (eg, alkylating agent chemotherapy), genetic susceptibilities, and other risk factors (eg, viral infections, tobacco use) among lymphoma subtypes contribute to the patterns of second malignancy risk. Elucidating these patterns may provide etiologic clues to lymphoma as well as to the second malignancies.

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Available from: Neil Caporaso, Aug 21, 2014
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    • "Furthermore, a cancer-free control population is commonly utilised that may lead to inaccuracy, as one cancer diagnosis increases the risk of development and detection of subsequent malignancies (Nugent et al, 2005; Morton et al, 2010; Royle et al, 2011b). "
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    ABSTRACT: Background: Chronic lymphocytic leukaemia (CLL) patients have an increased risk of other malignancies. This may be due to surveillance bias, treatment or immunosuppression. Methods: Cohort study of 612 consecutively diagnosed CLL patients in a Canadian province, with comparisons to follicular lymphoma (FL) patients. Results: Treated CLL patients had a 1.7-fold increased risk of second cancers compared with untreated CLL patients. As compared with untreated FL patients, untreated CLL patients had a two-fold increased incidence of second malignancies. Conclusion: Chronic lymphocytic leukaemia patients have an inherent predisposition to second cancers and the incidence is further increased by treatment.
    British Journal of Cancer 07/2013; 109(5). DOI:10.1038/bjc.2013.381 · 4.84 Impact Factor
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    • "One patient from our series died of anal carcinoma. A significantly increased risk of anal cancer has been reported after chemotherapy for NHL in patients with and without HIV infection (Hemminki et al, 2008; Morton et al, 2010), probably facilitated by human papylomavirus infection. Data regarding infection as a cause of death did not show differences between patients with or without cART: the frequency, the immunodeficiency status, and the time from lymphoma response to death were similar in both groups. "

    British Journal of Haematology 04/2013; 162(2). DOI:10.1111/bjh.12355 · 4.71 Impact Factor
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    • "W literaturze można prześledzić liczne badania przeprowadzone na mniejszych grupach chorych. W wielu z nich podkreślany jest znaczący wzrost ryzyka rozwoju raka płuca po diagnozie NHL [1, 2, 4, 11–18] dotyczący również chorych z postaciami indolentnymi chłoniaków [4] [18]. Lista nowotworów, na których rozwój może mieć wpływ zaburzenie nadzoru immunologicznego wywołane zachorowaniem na chłoniaka lub jego terapią, jest dłuższa. "
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    ABSTRACT: A clonal lymphocyte proliferation in patients with NHL interferes with the immune system, disturbing both humoral and cellular immunity. An antileukemic therapy additionally affects the immune system functioning. A higher than expected in general population incidence of infections and other malignancies is the consequence of impaired immunological surveillance. The fate of patients is also influenced by the possibility of low grade NHL transformation in more aggressive large B cell lymphoma, called the Richter's transformation.We present the case of patient with multiple malignancies small lymphocytic B-cell lymphoma (SLL), renal cell carcinoma (RCC), pulmonary adeno-carcinoma and recurrent laryngeal papillomas, that occurred in different stages of lymphoma diagnosis and treatment. He also developed SLL transformation in large B-cell lymphoma 7 years after the initial diagnosis.A clinical course, together with diagnostic and therapeutic difficulties we faced, are discussed in relation to the literature data.
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