Subsequent malignancies among long‐term survivors of Hodgkin lymphoma and non‐Hodgkin lymphoma: a pooled analysis of German cancer registry data (1990–2012)

Abstract

The increased risk of subsequent primary malignancies (SPM) in survivors of adult-onset Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) remains a challenging clinical problem worldwide. The German cancer registry database, pooled from 14 federal states, was used to calculate the standardized incidence ratio (SIR) and excess absolute risk (EAR) of SPM in 128 587 patients registered with first primary HL/NHL between 1990 and 2012. Conversely, SIRs were also calculated for a subsequent HL/NHL following other first cancers. The risk of developing SPM was significantly increased over twofold for HL survivors (SIR = 2·14, EAR = 51·87 cases/10 000 person-years) and 1·5-fold for NHL survivors (SIR = 1·48, EAR = 55·23) compared with the general German population. For solid cancers, SIRs were significantly elevated (1·6- and 1·4-fold; respectively) and were highest (threefold) in patients below 30 years of age upon initial diagnosis. Overall, SIRs were consistently elevated for lip/oral cavity, colon/rectum, lung, skin melanoma, breast, kidney and thyroid. Significantly increased SIRs for oesophagus, stomach, liver, pancreas, testis, prostate, and brain/central nervous system were observed following NHL only. For certain SPM, SIRs remained significantly elevated more than 10 years following HL/NHL diagnosis. Positive reciprocal associations were demonstrated between HL/NHL and several solid cancers mentioned above; for some, common aetiological mechanisms seem plausible.

Cancer risk following post‐transplant lymphoproliferative disorders in solid organ transplant recipients

“…Notably, exceptions to this pattern were observed for kidney and thyroid cancer, for which risks persisted >6 months after PTLD diagnosis, which is consistent with the risks observed among non‐Hodgkin lymphoma survivors in the general population (Baras et al , ). Due to the small number of PTLD cases, our results need to be replicated.…”

“…Nonetheless, our results combined with general population data support a potential role for shared risk factors or lymphoid malignancy treatment in the aetiology of kidney and thyroid cancer. However, the lack of association between PTLD and lung cancer or melanoma except in some patient subgroups contrasts with results for lymphoma survivors in the general population (Morton et al , ; Engels et al , ; Baras et al , ).…”

“…Solid organ transplant (SOT) recipients also have increased risks of other malignancies, particularly those with viral aetiologies (Engels et al , ). In the general population, lymphoma survivors have increased risk of subsequent cancers due to lymphoma treatment, underlying immune dysfunction or shared risk factors (Morton et al , ; Baras et al , ). We conducted the first assessment of cancer risk after PTLDs among SOT recipients and compared patterns to previous literature describing cancer risks after lymphoma in the general population.…”

Primary cutaneous CD4+ small‐/medium‐sized T‐cell lymphoproliferative disorder: A case report

“…The relative risk of subsequent malignancy increased between five and nine years after chemotherapy alone and remained elevated for 25 years and longer when combined therapies (with radiotherapy) were used. The risk was markedly higher when a chemotherapy included alkylators, as in our case . In addition, in our case the subsequent tumor developed in the area exposed to radiation during HL treatment, which might be responsible for the unusual localization.…”

“…The risk was markedly higher when a chemotherapy included alkylators, as in our case. [7][8][9] In addition, in our case the subsequent tumor developed in the area exposed to radiation during HL treatment, which might be responsible for the unusual localization.…”