Survival Patterns Among Lymphoma Patients With a Family History of Lymphoma

Abstract

A B S T R A C T PurposeGenetic factors are important in the etiology and pathogenesis of chronic lymphocytic leukemia (CLL), Hodgkin's lymphoma (HL), and non-Hodgkin's lymphoma (NHL). Only a few small studies have assessed clinical characteristics and prognosis for familial patients, with inconsistent findings. MethodsUsing population-based registries from Sweden and Denmark, 7,749 patients with CLL, 7,476 patients with HL, and 25,801 patients with NHL with linkable first-degree relatives were identified. Kaplan-Meier curves were constructed to compare survival in patients with lymphoma with and without a family history of lymphoma. The risk of dying was assessed using adjusted Cox proportional hazard models. ResultsWe found 85 patients with CLL (1.10%), 95 patients with HL (1.28%), and 206 patients with NHL (0.80%) with a family history of any lymphoma. Five-year mortality was similar for patients with CLL (hazard ratio [HR], 1.28; 95% CI, 0.95 to 1.72), HL (HR, 0.78; 95% CI, 0.49 to 1.25), and NHL (HR, 0.91; 95% CI, 0.74 to 1.12) versus without a family history of any lymphoma. Mortality was also similar for patients with versus without a family history of the same lymphoma. T-cell/ anaplastic lymphoma patients with a family history of NHL had poorer outcome 5-years after diagnosis (HR, 5.38; 95% CI, 1.65 to 17.52). Results were similar for 10 years of follow-up. ConclusionWith the exception of T-cell/anaplastic lymphoma, survival patterns for patients with CLL, HL, and NHL with a family history of lymphoma were similar to those for sporadic patients, suggesting that most familial lymphomas do not have an altered clinical course. Our findings provide no evidence to modify therapeutic strategies for patients with CLL, HL, or NHL based solely on family history. J Clin

Host genetics in follicular lymphoma

“…The most comprehensive data are from a study using population-based registries in Sweden and Denmark that identified 25,801 patients with NHL, of whom 206 had a first degree relative with any lymphoma [43]. In that study, mortality at 5 years (HR=0.91, 95% CI 0.74-1.12) and 10 years (HR=0.97, 95% CI 0.80-1.16) was not related to family history.…”

How I treat CLL up front

“…In a report from the National Cancer Institute Familial Registry, the mean age at diagnosis among familial cases was 58 years, 14 years younger than that of sporadic cases. 3 There is no difference in survival from diagnosis in familial compared with nonfamilial cases of CLL, 4 and no increased risk of transformation to more aggressive non-Hodgkin lymphomas. Apart from the difference in age at presentation, familial CLL is essentially indistinguishable from sporadic CLL, favoring a genetic basis to disease development in general rather than a simple environmental etiology.…”

Family Refusal of Chemotherapy for Pediatric Cancer Patients

“…2 This improvement is due primarily to the establishment of protocolbased chemotherapy in the setting of carefully designed clinical research. 3,4 Over this time, medicine has largely shifted from a paradigm of paternalism to shared decision making. In pediatrics, this often includes direct parental involvement in management decisions.…”