Secondary malignancies after treatment for indolent non-Hodgkin's lymphoma: a 16-year follow-up study

Sacchi, Stefano; Marcheselli, Luigi; Bari, Alessia; Marcheselli, Raffaella; Pozzi, Samantha; Luminari, Stefano; Lombardo, Marco; Buda, Gabriele; Lazzaro, Antonio; Gobbi, Paolo G.; Stelitano, Caterina; Morabito, Fortunato; Quarta, Giovanni; Brugiatelli, Maura

doi:10.3324/haematol.12120

Cited by 92 publications

(51 citation statements)

References 24 publications

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“…In contrast to our results, Sacchi et al 20 reported 12 cases of t-MDS/AML in an analysis of 563 previously untreated non-Hodgkin's lymphoma (NHL) patients followed for a median of 62 months. Although there was a trend toward an increased relative risk for secondary malignancy in the fludarabine treated group, it was not statistically significant (P ¼ 0.074), and no association between fludarabine and the development of t-MDS/AML was identified.…”

Section: Discussioncontrasting

confidence: 53%

Fludarabine as a risk factor for poor stem cell harvest, treatment-related MDS and AML in follicular lymphoma patients after autologous hematopoietic cell transplantation

Waterman

Rybicki

Bolwell

et al. 2011

Bone Marrow Transplant

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Fludarabine is an effective treatment for follicular lymphoma (FL), but exposure to it negatively impacts stem cell mobilization and may increase the risk of subsequent myelodysplastic syndrome and acute myelogenous leukemia (t-MDS/AML). We hypothesized that the risk that fludarabine imparts to stem cell mobilization and t-MDS/AML would be affected by dose or timing. All patients with FL treated at Cleveland Clinic from 1991 to 2007 with autologous hematopoietic cell transplantation were evaluated. Recursive partitioning analysis was used to explore associations of fludarabine and mitoxantrone dose and timing with poor stem cell harvest and t-MDS/ AML. We identified 171 patients, of whom 52 previously received fludarabine. Patients exposed to fludarabine prior to auto-HCT were more likely to require 45 days of leukapheresis (Po0.001) and second stem cell mobilization (Po0.001), especially at a cumulative dose 4150 mg/m 2 . Univariable risk factors for t-MDS/AML included the number of chemotherapy regimens before auto-HCT, the need for 45 days of leukapheresis to collect CD34 þ cells and fludarabine exposure in a dosedependent manner, particularly when 4500 mg/m 2 . A cumulative dose of fludarabine 4150 mg/m 2 increases the risk for poor stem cell harvests and any exposure increases the risk of t-MDS/AML, with the greatest risk being at doses 4500 mg/m 2 .

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Section: Discussioncontrasting

confidence: 53%

Fludarabine as a risk factor for poor stem cell harvest, treatment-related MDS and AML in follicular lymphoma patients after autologous hematopoietic cell transplantation

Waterman

Rybicki

Bolwell

et al. 2011

Bone Marrow Transplant

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“…Despite a few reports to the contrary, [14][15][16] the majority of published studies have shown that non-Hodgkin's lymphoma patients are at a greater risk of second malignancies. [7][8][9][10][11][12][13] These conflicting results could be explained in part by the different epidemiological and statistical methods utilized for evaluating the incidence of second cancers. 38 Two commonly used epidemiological designs are cohort and case-control studies.…”

Section: Discussionmentioning

confidence: 97%

“…Several studies, [7][8][9][10][11][12][13] but not all, [14][15][16] have reported an increased overall risk of second cancer after treatment for non-Hodgkin's lymphoma. However, in a large majority of the research, all the categories of nonHodgkin's lymphoma were combined for analysis.…”

Section: Introductionmentioning

confidence: 99%

Second malignancies after treatment of diffuse large B-cell non-Hodgkin's lymphoma: a GISL cohort study

Sacchi¹,

Marcheselli²,

Bari³

et al. 2008

Haematologica

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BACKGROUND: Improved treatment has increased the life expectancy of patients with non-Hodgkin's lymphoma, but few studies have addressed the issue of second cancer in patients treated for diffuse large B-cell lymphoma. The aims of this study were to determine the incidence and time free of second cancers in this subset of patients. DESIGN AND METHODS: We evaluated a cohort of 1280 patients with diffuse large B-cell lymphoma who were first treated between 1988 and 2003. We utilized the central database of the Gruppo Italiano Studio Linfomi, which includes data on demographics, clinical characteristics, laboratory parameters, treatment and follow-up of all patients with non-Hodgkin's lymphoma enrolled in clinical trials. RESULTS: After a median follow-up of 51 months, 48 patients had developed a second cancer: 13 hematologic malignancies and 35 solid tumors. The overall standardized incidence ratio in our cohort (with a median age of 58 years) matched that of the general Italian population. The incidence ratio of second tumors was age related, and the age groups 20-39 and 40-59 years showed an increased risk. Overall, the cumulative incidence of second cancer was 8.2% at 15 years. A multivariate analysis showed that older age at the time of diagnosis of lymphoma had a negative influence on the time free of second tumors. CONCLUSIONS: In our cohort, only young patients showed an increased incidence ratio of second malignancies, while the incidence ratio in patients aged over 59 years matched the incidence in the Italian general population. Demographics, baseline characteristics, laboratory parameters and treatment modalities did not have any significant impact on the incidence ratio of a second cancer

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“…The risk of secondary malignancies following delivery of EBRT has been identified previously in a number of studies (7)(8)(9)(10). Known risk factors for this include a younger age at diagnosis, high radiation dose and being of the female gender (11).…”

Section: Discussionmentioning

confidence: 99%

Cholangiocarcinoma following external beam radiotherapy: A report of two cases

et al. 2017

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Secondary malignancies after treatment for indolent non-Hodgkin's lymphoma: a 16-year follow-up study

Cited by 92 publications

References 24 publications

Fludarabine as a risk factor for poor stem cell harvest, treatment-related MDS and AML in follicular lymphoma patients after autologous hematopoietic cell transplantation

Fludarabine as a risk factor for poor stem cell harvest, treatment-related MDS and AML in follicular lymphoma patients after autologous hematopoietic cell transplantation

Second malignancies after treatment of diffuse large B-cell non-Hodgkin's lymphoma: a GISL cohort study

Cholangiocarcinoma following external beam radiotherapy: A report of two cases

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