Risk of second primary cancer after Hodgkin's disease in patients in the British National Lymphoma Investigation: relationships to host factors, histology and stage of Hodgkin's disease, and splenectomy

Abstract Introduction. The risk of developing a second primary cancer (SPC) is increased in patients with CLL. The mechanisms explaining this association could be related to lifestyle, environment, host factors or interactions or other influences. We conducted an epidemiological study based on 10 French registries and evaluated the risk of developing SPC in patients with CLL. Methods. Data from French population-based registries were used to establish a cohort of all patients diagnosed with a first cancer between 1989 and 2004 and followed-up until December 31, 2007. The person-year approach was used to estimate Standardized Incidence Ratios (SIRs) and Excess Absolute Risks (EARs) of metachronous SPC. Multivariate Poisson regression modules were then used to model SIRs and EARs separately by gender, adjusting for age, year of diagnosis, follow-up and first cancer site. All patients with CLL did not have HIV/AIDS-related disease. Results. Among 288,967 patients, 21,226 patients (7.5%) developed SPC. Among 4,148 CLL patients (Male: 2,336, Female: 1,812, median age: 70 years), 479 patients (11.5%) developed SPC after a median time of 54 months (2-199). EARs of SPC are different between male and female. In male, localizations of SPC are lung, bronchus and trachea, colorectum, colon, stomach and Hodgkin's disease. Their respective EARs are shown in table 1 and no excess absolute risk was observed for 24 other localizations. In female, localizations of SPC are rectum, stomach and melanoma of skin. Their respective EARs are shown in table 2 and no excess absolute risk was observed for 21 other localizations. Table 1: Excess Absolute Risks (EARs) of second primary cancer (SPC) for male Male SIR SIR IC95% EAR EAR IC95% Lung, bronchus and trachea 2.08 1.61 2.64 26.1 14.8 39.8 Colorectum 1.54 1.15 2.03 13.2 3.7 25.1 Colon 1.63 1.11 2.3 9.3 1.6 19.2 Stomach 1.91 1.07 3.15 5.4 0.4 12.7 Hodgkin's disease 8.71 2.34 22.29 2.7 0.5 7.4 Table 2: Excess Absolute Risks (EARs) of second primary cancer (SPC) for female Female SIR SIR IC95% EAR EAR IC95% Rectum 2.17 1.19 3.64 6.7 1.1 15.2 Stomach 3.04 1.45 5.58 6 1.3 13.4 Melanoma of skin 2.59 1.04 5.34 3.8 0.1 10.4 Conclusion. The risk for developing SPC after CLL is increased for male and female, especially solid cancers. Except Hodgkin's disease for male patients, there is no increase for other malignant hematological diseases, including acute leukemia and myelodysplastic syndrome. CLL survivors face a high risk of new malignancies and the excess risk of SPC increases with follow-up. As the SPC risk is closely tied to patient's characteristics, a personalized surveillance is required to allow optimal SPC prevention and early detection strategies. Disclosures No relevant conflicts of interest to declare.

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Second primary cancer following Hodgkin's disease: updated results of an Italian multicentric study.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.3.432 ◽

1991 ◽

Vol 9 (3) ◽

pp. 432-437 ◽

Cited By ~ 67

Author(s):

G Cimino ◽

G Papa ◽

S Tura ◽

P Mazza ◽

P L Rossi Ferrini ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Treatment Modalities ◽

Second Primary ◽

Primary Cancer ◽

Second Primary Cancer ◽

Multicentric Study ◽

Significant Difference ◽

Actuarial Risk

The risk of second primary cancer (SPC) was evaluated in 947 patients treated for Hodgkin's disease (HD) during the period January 1969 to December 1979. The median follow-up of this series was 10.5 years (range, 9 to 19). Treatment categories included radiotherapy (RT) alone (115 patients, 12%), chemotherapy (CHT) alone (161 patients, 17%), combined RT plus CHT (381 patients, 40%), and salvage treatment for resistant or relapsing HD (290 patients, 30.6%). Fifty-six SPCs were observed, occurring between 1 and 17 years from initial treatment. Among these, secondary acute nonlymphoid leukemia (s-ANLL) was the most frequent SPC (23 cases). Secondary non-Hodgkin's lymphoma (s-NHL) occurred in 5 patients, whereas a secondary solid tumor (s-ST) was observed in 28 patients. The calculated actuarial risk (+/- SE) of developing SPC was 5.0% (+/- 0.9%) and 23.1% (+/- 5.8%) at 10 and 19 years, respectively. Concerning treatment modalities and s-ANLL risk, no cases were observed in the radiotherapy group, whereas CHT plus RT and salvage groups showed the highest actuarial risk. This was, in fact, at 10 and 19 years, 3.1% (+/- 0.9%) and 8.1% (+/- 4.0%) in the former group, and 1.8% (+/- 1.0%) and 16% (+/- 9.0%) in the latter. A statistically significant difference was observed when the CHT plus RT group was compared with CHT and RT groups (P = .04). Concerning the relationships with chemotherapeutic regimens, 12 s-ANLL cases occurred in the mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus RT group, and only one case in the group receiving doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) plus RT. A statistically significant difference of s-ANLL actuarial risk was found comparing patients receiving MOPP plus RT to all other treatment groups (P = .04). With respect to s-ST, the actuarial risk at 10 and 19 years was 2.0% (+/- 0.6%) and 13.0% (+/- 3.8%), respectively. No significant differences were found among groups treated with different modalities. These data were confirmed by a multivariate analysis, which indicated treatment modality and age as independent variables for s-ANLL and s-ST development, respectively. Based on the prolonged follow-up analysis, the actuarial SPC risk at 10 years hereby reported should reflect the real SPC incidence in our series.

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