scholarly journals Stomach Cancer in a Patient with Chronic Lymphocytic Leukaemia

2019 ◽  
Vol 9 (2) ◽  
pp. 125-131
Author(s):  
R. A. Maier ◽  
B. A. Bakirov ◽  
M. V. Timerbulatov

Introduction. Chronic lymphocytic leukaemia (CLL) is a malignant clonal lymphoproliferative disorder characterised by the accumulation of atypical mature CD5/CD19/CD23-positive B lymphocytes, predominantly in blood, bone marrow, lymph glands, liver and spleen. Chemotherapy protocols with the inclusion of nucleotide analogues, alkylating drugs and monoclonal antibodies are currently the standard of treatment. FCR (fludarabine, cyclophosphamide, rituximab) is one of the most effective protocols. CLL may lead to various immunologic disorders resulting in an increased risk of a malignant neoplasm. This paper aims to present a demonstration of a case of the combination of chronic lymphocytic leukaemia and stomach cancer, and an attempt to establish — based on literature data — a link between the diagnosed stomach adenocarcinoma and the main disease.Materials and methods. Authors have analysed the case history, laboratory and instrumental data and the treatment of a patient with chronic lymphocytic leukaemia and stomach adenocarcinoma.Results and discussion. The patient E., 63 yo, was diagnosed with chronic lymphocytic leukaemia in 2016. The patient was started on FCR chemotherapy protocol (Fludarabine, 70 mg days 2-4 of CT, Endoxan 500 mg days 2-4 of the cycle, Rituximab 700 mg day 1 od CT) in June 2018. When the patient came to the BSMU hospital for a chemotherapy cycle in August 2018, gastric endoscopy was performed; tissue pathology examination resulted in the diagnosis of stomach adenocarcinoma. A concilium of surgeons, oncologists and haematologists made a decision to perform a gastrectomy with the oesophageal resection and Roux anastomosis.Conclusion. Having used a clinical case as an example and reviewed available literature, the authors have demonstrated that either CLL or the immunosuppressed status served as the causal factors for the development of the adenocarcinoma. The development of stomach adenocarcinoma in patients with chronic lymphocytic leukaemia makes the course and outcome of the main disease much more severe. A decision regarding the management strategy for such patients has to make individually every time, taking into account the severity of the oncological disease; this impacts on the choice of the treatment protocol. All the cases of spontaneous remissions in patients with lymphocytic leukaemia must be screened extensively in order to facilitate early diagnosis of malignant neoplasms.

2013 ◽  
Vol 93 (1) ◽  
pp. 157-162 ◽  
Author(s):  
E. C. van den Broek ◽  
L. Liu ◽  
E. F. M. Posthuma ◽  
M. L. G. Janssen-Heijnen ◽  
J. W. W. Coebergh ◽  
...  

Author(s):  
N. N. Antonenkova ◽  
M. V. Malko ◽  
A. M. Pashkevich

The article presents a simplified analytical method of evaluating the cancer incidence in first-degree relatives with glial brain tumors. The method is based on the use of population cancer incidence rates in the Belarus population and the estimated numbers of first-degree relatives in the time interval corresponding to the average life span in the Belarus population. This method was employed to analyze the cancer incidence in the patients of first-degree relatives who were treated at the N.N. Alexandrov National Cancer Centre. Their diagnosis was the glial brain tumor. The number of the investigated first-degree relatives was 1012, of them 502 were males and 510 – females. As of December 31, 2015, this group had 63 cases of malignant neoplasms. According to the findings of the analysis performed, the first-degree relatives are at an increased risk for brain, rectum, thyroid and corpus uteri cancers. However, the statistically significant risk was found only for brain cancer incidence. The standardized incidence rate in first-degree relatives was 3.39 for this site (95 % CI 1.10–7.92), which is consistent with the data obtained by specialists of other countries (USA, Sweden and others).The agreement of the standardized incidence values suggests that the simplified analytical method provides an adequate account of the incidence among the patients of first-degree relatives with an established diagnosis of malignant neoplasm.


1987 ◽  
Vol 63 (738) ◽  
pp. 253-256 ◽  
Author(s):  
M. Lishner ◽  
M. Prokocimer ◽  
E. Ron ◽  
M. Shaklai

Blood ◽  
2009 ◽  
Vol 114 (7) ◽  
pp. 1314-1318 ◽  
Author(s):  
Martin Stanulla ◽  
Elke Schaeffeler ◽  
Anja Möricke ◽  
Sally A. Coulthard ◽  
Gunnar Cario ◽  
...  

AbstractThiopurine methyltransferase (TPMT)is involved in the metabolism of thiopurines such as 6-mercaptopurine and 6-thioguanine. TPMT activity is significantly altered by genetics, and heterozygous and even more homozygous variant people reveal substiantially decreased TPMT activity. Treatment for childhood acute lymphoblastic leukemia (ALL) regularly includes the use of thiopurine drugs. Importantly, childhood ALL patients with low TPMT activity have been considered to be at increased risk of developing therapy-associated acute myeloid leukemia and brain tumors. In the present study, we genotyped 105 of 129 patients who developed a secondary malignant neoplasm after ALL treatment on 7 consecutive German Berlin-Frankfurt-Münster trials for all functionally relevant TPMT variants. Frequencies of TPMT variants were similarly distributed in secondary malignant neoplasm patients and the overall ALL patient population of 814 patients. Thus, TPMT does not play a major role in the etiology of secondary malignant neoplasm after treatment for childhood ALL, according to Berlin-Frankfurt-Münster strategies.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4692-4692
Author(s):  
Andrew Weston ◽  
Marie Hughes ◽  
Gillian Corbett ◽  
Neil Graham ◽  
Franz Strydom

Abstract Background/Aims: Chronic lymphocytic leukaemia (CLL) incurs an increased risk of developing second primary malignancies (SPMs). The pathogenesis underpinning this increased SPM risk is attributable to synergism between genetic aberrations, chronic immune suppression / dysfunction and CLL treatments. Specifically, CLL associated skin cancer is a well-documented phenomenon, with common malignancies such as squamous (SCC) and basal cell (BCC) carcinomas occurring at higher frequencies in CLL patients and are often of a more aggressive phenotype. The incidence of non-melanoma skin cancers (NMSCs) among New Zealand CLL patients is unknown, as NMSCs are not required to be reported to the New Zealand Cancer Registry. Accordingly, this study aimed to analyse the incidence of NMSC in CLL patients from the Bay of Plenty region of New Zealand. Methods: We conducted a retrospective analysis of 213 CLL patients, who were referred to Bay of Plenty District Health Board (BOPDHB) between 2015 and 2020, for the occurrence of SPMs. Clinical notes were reviewed for the demographics of sex, age at time of CLL diagnosis, CLL treatments received and occurrence and type of NMSCs. A control group of 76 patients referred to BOPDHB haematology, for anaemia or thrombocytopenia, of which the cause subsequently remained unknown and was not associated with lymphoproliferative disease, was reviewed for primary malignancy (PM), occurrence and type. NMSC incidence was also compared to a local data, on overall NMSC incidence in the general Bay of Plenty population, in 2015. Results: The predominant SPM types occurring in this CLL patient group were NMSCs. A total of 249 and 170 histological diagnoses of SCC and BCC were made in our group of CLL patients, respectively. Of the 213 CLL patients, 48.8% had a diagnosis of at least one NMSC, with median time between CLL and NMSC diagnosis of 5 years (range, -6 to 19 years). CLL patients that were diagnosed with NMSC developed a mean number of 3.93 ± 2.94 separate lesions, compared to 2.6 ± 1.7 lesions in our control population. Note: comparison of NMSC incidence data between CLL group and Bay of Plenty population Conclusion: Patients with CLL are at increased risk of developing multiple NMSC lesions. Therefore, we believe CLL patients should be assessed by dermatologists or general practitioners for whole-body skin examination, 6 monthly following their CLL diagnosis. This strategy promotes early diagnosis, and patient education on importance of sun protection strategies to reduce NMSC risk. This is essential to the ongoing care of CLL patients in a NZ context, given the increased incidence of NMSC associated with CLL, in combination with the high levels of UV exposure and skin damage among the NZ general population. This study also highlights how NMSC disease burden is likely to be significantly underestimated due to a lack of data collection on these malignancies by the New Zealand Cancer Registry. Disclosures No relevant conflicts of interest to declare.


2016 ◽  
Vol 26 (2) ◽  
pp. 188-194 ◽  
Author(s):  
Catherine M. Olsen ◽  
Steven W. Lane ◽  
Adèle C. Green

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 682-682
Author(s):  
Luciano J. Costa ◽  
Kelly N. Godby ◽  
Saurabh Chhabra ◽  
Robert Frank Cornell ◽  
Parameswaran Hari ◽  
...  

Background: The management of patients with multiple myeloma (MM) has evolved significantly over the last two decades with increased utilization of autologous hematopoietic cell transplantation (AHCT) and introduction of proteasome inhibitors (PIs) and immunomodulatory agents (IMIDs) and concomitant improvement in survival, particularly in younger patients. Both AHCT and the IMID lenalidomide have been associated with increased risk of second malignant neoplasms (SMN) in clinical trials, with the risk reaching 6.9% at 5 years in a recent meta-analysis. We intended to assess whether an increase in incidence of SMN was evident at the population level and the impact of the changing SMN risk on survival of MM patients. Methods: We utilized the Surveillance, Epidemiology and End Results 13 (SEER 13) registries to analyze three cohorts of patients: those diagnosed during 1995-1999 (pre-thalidomide, limited use of AHCT, 15 years of follow up), 2000-2004 (post-thalidomide, pre lenalidomide and bortezomib, increased utilization of AHCT, 10 years of follow up) and 2005-2009 (post-lenalidomide and bortezomib, higher utilization of AHCT, 5 years of follow up). Follow up is current to the end of 2014. We included patients younger than 65 years at the time of diagnosis of MM as first malignant neoplasm to focus the analysis in patients more likely to receive AHCT and presumably prolonged lenalidomide exposure. For each cohort, we calculated the incidence of SMN considering death from any cause as a competing risk. Since comparison by era is subject to confounding by attained age, we analyzed and compared standardized incidence ratios (SIRs) for SMN and causes of death (COD) in intervals of 5 years: years 1-5 and years 6-10 from diagnosis. Results: There were 2,720 patients in the 1995-1999, 3,246 in the 2000-2004 and 3,867 in the 2005-2009 cohort. Median age of diagnosis was 56 years and 56.6% of the patients were males with no differences across cohorts. Non-Hispanic Whites were 55.9%, non-Hispanic Blacks 23.2%, Hispanics 12.6% and individuals of other race/ethnicities 8.2%. Median follow up of survivors was 198 months (range 1-239), 141 months (range 1-179) and 81 months (range 0-119) in the 1995-1999, 2000-2004 and 2005-2009 cohorts respectively. Cumulative incidences of SMN at 90 months were 4.7% (95% C.I. 4.0-5.6%), 6.0% (95% C.I. 5.2%-6.8%) and 6.3% (95% C.I. 5.5%-7.1%), respectively in the 3 consecutive cohorts, P=0.0008. The statistically significant, yet small increase in SMN is accompanied with decline in all-cause mortality in the same period from 69.9% for the 1995-1999 cohort to 60.4% for the 2000-2004 cohort to 52.8% for the 2005-2009 cohort, P<0.0001. During years 1-5 after MM diagnosis, the risk of another cancer of any type evolved from lower than expected in an age, gender and race-matched population for patients diagnosed in 1995-1999 (SIR=0.77, 95% C.I. 0.59-0.99) to similar to expected for patients diagnosed in 2005-2009 (SIR=1.15, 95% C.I. 0.97-1.36), driven particularly by increase in hematologic malignancies from SIR=1.28 (95% C.I. 0.47-2.78) to SIR=2.17 (95% C.I. 1.27-3.48),(Figure). For years 6-10, the overall risk of subsequent malignancy in MM survivors is similar to the matched population for both the 1995-1999 and the 2000-2004 cohorts (most recent cohort with 10-year follow up). However, the risk of subsequent hematologic malignancy is increased in both periods with the most substantial change being in the risk of lymphomas evolving from SIR=0.59 (95% C.I. 0.01-3.29) for the 1995-1999 cohort to SIR=3.31 (95% C.I. 1.51-6.27) for the 2000-2004 cohort. As expected, overall mortality in years 1-5 declined sharply across the three cohorts (Table), driven by decline in both MM-associated (from 159.4 to 91.7/1,000 patient-year) and cardiovascular mortality (from 12.6 to 9.1/1,000 patient-year). Importantly, there was no discernible increase in risk of death from SMN (from 4.5 to 3.9/1,000 patient-year). Conclusions: This population study confirms that the evolution of MM therapy in the US in the last 20 years is associated with a small, statistically significant increase in the risk of SMN in patients <65 years. Such increase is driven mostly by the increased incidence of hematologic malignancies. The study also demonstrates that the mortality from SMN is modest, has not significantly increased over time and is obscured by the robust reduction in mortality from MM. Disclosures No relevant conflicts of interest to declare.


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