Risk of second cancer after chronic lymphocytic leukemia

Abstract

Smoking is not considered a risk factor for chronic lymphocytic leukemia (CLL) yet increased lung cancer risk has been reported for these patients. Little data exist on the temporal variation in lung cancer risk after CLL, or its histological composition. We investigated the occurrence of second cancers in a large cohort of CLL patients with particular emphasis on lung cancer and its major subtypes. We followed all patients diagnosed with CLL in Denmark in the period 1943-2003 (n 5 12,373) for the occurrence of second cancers. The relative risk was expressed as the standardized incidence ratio (SIR), i.e. the ratio of observed to expected number of cancers, based on incidence rates for the Danish population. During follow-up 1,105 cancers occurred among the CLL patients (SIR 5 1.59 (95% CI 1.50-1.69)). SIR for all cancers combined remained elevated more than 10 years after CLL (SIR 5 1.80 (1.56-2.08)). Lung cancer occurred in 141 patients (SIR 5 1.61 (1.37-1.90)). The relative risk of lung cancer did not vary by gender, or time of follow-up, but was higher in younger (SIR <60 years 5 2.22 (1.62-3.06)) than in older (SIR 70-79 years 5 1.21 (0.88-1.68)) age-groups. Elevated risks were observed for adenocarcinoma (SIR 5 2.20 (1.57-3.08)) and squamous cell carcinoma (SIR 5 1.52 (1.06-2.17)) of the lung. We speculate that shared genetic risk factors may explain the accumulation of lung and other cancers in CLL patients. ' 2007 Wiley-Liss, Inc.Key words: CLL; second cancer; cohort study; epidemiology In Western countries chronic lymphocytic leukemia (CLL) accounts for 25-30% of all leukemias.1 Clinically the disease varies substantially: while in many patients it remains indolent with no need for treatment, in others it displays an aggressive clinical course. Consequently the 7-years median survival time for CLL ranges from a few months to several decades. 2The causes of CLL largely have remained unestablished, 3-5 but there is increasing evidence that its development involves both constitutional and environmental factors. 6,7 Little is known about the nature of these factors, but important clues could emanate from studies of comorbidity in CLL patients, e.g. the occurrence of second cancers.Previous studies have indicated that patients with CLL have an increased risk of subsequent cancer, in particular cancers of the skin and lung. [8][9][10][11][12] Several mechanisms have been discussed for the association between these cancers. The increased risk of lung cancer is particularly noteworthy, because smoking has so far not been linked with CLL risk. 13,14 In previous Danish 11 and American 10 studies, the increased risk of lung cancer was found to be independent of time since CLL diagnosis, leading to the conclusion that it could not be attributed to CLL treatment offered no explanation for the observed increased lung cancer risk. However, concomitant with the introduction of new treatment strategies including the nucleoside analog Fludarabine, other studies have reported both increased risk of lung cancer, 15-17 an...

Társult tumorok előfordulása krónikus lymphoid leukaemiában

“…Ugyanakkor több szerző a CLL utáni szekunder neoplasmák gyakoriságának jelentős emelkedéséről számolt be [2][3][4][5][6][7][8], amelyek között a leggyakoribb rákfajtákon (colorectalis, hörgő-, emlő-, prostata-cc) kí-vül szokatlanul magas arányban fordultak elő bőrlap-hám-cc-k és részben melanomák [1,7,9,10,[12][13][14], s ezek prognózisa is az átlagosnál kedvezőtlenebb. Saját beteganyagunkban szintén az esetek felében (50,5%) a CLL volt az első felismert rosszindulatú kórkép, és a szinkron előfordulás is gyakori (25,3%) volt.…”

“…Hisada és mtsai 16 376 beteg utánkövetése során 5%-ukban találtak újabb daganatot (másodlagos hematológiai kórképeken kívül), a második tumor kialakulásának kockázatát a CLL diagnózisát követő egy éven belül és tíz éven túl hasonlónak találták [5]. Schöllkopf és mtsai 12 373 CLL-es betegük sorsát követték nyomon, köztük 1105-ben (11,2%) alakult ki szekunder malignoma, 10 év követés után is minden ráktípus megjelenése gyakoribb maradt [6]. Morton és mtsai a CLL-ben a hör-gőrákot és melanomát találták a leggyakoribb daganatnak [7].…”

An unusual simultaneous occurence of gastric adenocarcinoma, leiomyoma and B-cell small lymphocytic lymphoma involving the perigastric lymph nodes and spleen

“…Acute gastric volvulus is a rare disease that requires a high index of suspicion for diagnosis and rapid treatment (1,2). Many cases occur with a paraesophageal hernia (3).…”

“…Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a low-grade, indolent, systemic neoplasm of monomorphic small, round, B-lymphocytes in the peripheral blood, bone narrow and lymph nodes (1). This disease exhibits a variety of immunologic impairments that might increase the risk of second malignancy (1,2).…”

“…This disease exhibits a variety of immunologic impairments that might increase the risk of second malignancy (1,2). In fact, there is evidence that the risk of development of non-hematologic malignancies is increased in patients with CLL/SLL, compared with that of the general population.…”