Risk and Outcome of Second primary malignancy in patients with classical Hodgkin lymphoma

Abstract

BACKGROUND Hodgkin lymphoma survivors demonstrated increased risk of secondary primary malignancies (SPMs), but comprehensive analysis of the risk and outcome of SPMs in classical Hodgkin lymphoma (cHL) patients has not yet been reported. METHODS Patients with classical Hodgkin Lymphoma from 1975 to 2017 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Standardized incidence ratios (SIRs) were calculated for the risk of solid and hematologic SPMs in cHL patients compared to the general population. The outcome of cHL patients developing SPMs were assessed by performing survival, competing risks regression and cox proportional regression analyses. RESULTS In a follow-up of 26,493 cHL survivors for 365,156 person years, 3,866 (14.59%) secondary cancers were identified, with an SIR of 2.09 (95% CI: 2.02 - 2.15). The increased risk was still notable after follow-up of 10 years or more, and the risk is more pronounced for patients with female gender, younger age, advanced stage, chemotherapy and radiation therapy. The overall survival is worse for cHL patients with SPMs after 5 years of follow-up (P < 0.0001). The main cause of death for cHL patients with SPMs is not cHL but other causes including SPMs. Multivariate Cox regression analysis confirmed SPMs as an independently adverse prognostic factor for cHL survivors (hazard ratio, 1.08; 95% CI, 1.03-1.14, P = 0.002). CONCLUSIONS There is a significantly increased risk of developing SPMs for cHL survivors. The overall survival is worse for cHL patients and SPMs is an independent prognostic factor for cHL.

Correlation between lymphoma and second primary malignant tumor

“…[14,15] Whereas in 2020 a case-control study in China showed that first-line treatment and the effect of thoracic or mediastinal radiotherapy were independent factors that led to the death of patients with lymphoma from a second primary tumor. [16] In our study, it was found that treatment factors did not play an absolute role in the risk of developing SPMs, chemoradiotherapy did not directly affect the cumulative incidence of lymphoma producing different types of SPMs, but radiotherapy/ chemotherapy was a relevant factor for lymphoma producing specific types of SPMs. In specific subtypes of SPMs, the effect of radiotherapy or chemotherapy on the generation of SPMs is both protective and dangerous in patients with different clinical features.…”