Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia

Vivek Kumar, Sikander Ailawadhi, Leyla Bojanini, Aditya Mehta, Suman Biswas, Taimur Sher, Vivek Roy, Prakash Vishnu, Julian Marin-Acevedo, Victoria R. Alegria, Aneel Paulus, Sonikpreet Aulakh, Madiha Iqbal, Rami Manochakian, Winston Tan, Asher Chanan-Khan, Meghna Ailawadhi

Research output: Contribution to journalArticle

Abstract

With improving survivorship in chronic lymphocytic leukemia (CLL), the risk of second primary malignancies (SPMs) has not been systematically addressed. Differences in risk for SPMs among CLL survivors from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) were compared to risk of individual malignancies expected in the general population. In ~270,000 person-year follow-up, 6487 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95% CI:1.17–1.23). The higher risk was for both solid (SIR 1.15; 95% CI:1.12–1.18) and hematological malignancies (SIR 1.61; 95% CI:1.5–1.73). The highest risk for SPMs was noted between 2 and 5 months after CLL diagnosis (SIR 1.57; 95% CI:1.41–1.74) and for CLL patients between 50- and 79-years-old. There was a significant increase in SPMs in years 2003–2015 (SIR 1.36; 95% CI:1.3–1.42) as compared to 1973–1982 (SIR 1.19; 95% CI:1.12–1.26). The risk of SPMs was higher in CLL patients who had received prior chemotherapy (SIR 1.38 95% CI:1.31–1.44) as compared to those untreated/treatment status unknown (SIR 1.16, 95% CI:1.13–1.19, p < 0.001). In a multivariate analysis, the hazard of developing SPMs was higher among men, post-chemotherapy, recent years of diagnosis, advanced age, and non-Whites. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL.

Original languageEnglish (US)
Article number75
JournalBlood cancer journal
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2019

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Second Primary Neoplasms
B-Cell Chronic Lymphocytic Leukemia
Survivors
Incidence
Survival Rate
Drug Therapy
Hematologic Neoplasms
Epidemiology
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Hematology
  • Oncology

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Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia. / Kumar, Vivek; Ailawadhi, Sikander; Bojanini, Leyla; Mehta, Aditya; Biswas, Suman; Sher, Taimur; Roy, Vivek; Vishnu, Prakash; Marin-Acevedo, Julian; Alegria, Victoria R.; Paulus, Aneel; Aulakh, Sonikpreet; Iqbal, Madiha; Manochakian, Rami; Tan, Winston; Chanan-Khan, Asher; Ailawadhi, Meghna.

In: Blood cancer journal, Vol. 9, No. 10, 75, 01.10.2019.

Research output: Contribution to journalArticle

Kumar, V, Ailawadhi, S, Bojanini, L, Mehta, A, Biswas, S, Sher, T, Roy, V, Vishnu, P, Marin-Acevedo, J, Alegria, VR, Paulus, A, Aulakh, S, Iqbal, M, Manochakian, R, Tan, W, Chanan-Khan, A & Ailawadhi, M 2019, 'Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia', Blood cancer journal, vol. 9, no. 10, 75. https://doi.org/10.1038/s41408-019-0237-1
Kumar, Vivek ; Ailawadhi, Sikander ; Bojanini, Leyla ; Mehta, Aditya ; Biswas, Suman ; Sher, Taimur ; Roy, Vivek ; Vishnu, Prakash ; Marin-Acevedo, Julian ; Alegria, Victoria R. ; Paulus, Aneel ; Aulakh, Sonikpreet ; Iqbal, Madiha ; Manochakian, Rami ; Tan, Winston ; Chanan-Khan, Asher ; Ailawadhi, Meghna. / Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia. In: Blood cancer journal. 2019 ; Vol. 9, No. 10.
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abstract = "With improving survivorship in chronic lymphocytic leukemia (CLL), the risk of second primary malignancies (SPMs) has not been systematically addressed. Differences in risk for SPMs among CLL survivors from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) were compared to risk of individual malignancies expected in the general population. In ~270,000 person-year follow-up, 6487 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95{\%} CI:1.17–1.23). The higher risk was for both solid (SIR 1.15; 95{\%} CI:1.12–1.18) and hematological malignancies (SIR 1.61; 95{\%} CI:1.5–1.73). The highest risk for SPMs was noted between 2 and 5 months after CLL diagnosis (SIR 1.57; 95{\%} CI:1.41–1.74) and for CLL patients between 50- and 79-years-old. There was a significant increase in SPMs in years 2003–2015 (SIR 1.36; 95{\%} CI:1.3–1.42) as compared to 1973–1982 (SIR 1.19; 95{\%} CI:1.12–1.26). The risk of SPMs was higher in CLL patients who had received prior chemotherapy (SIR 1.38 95{\%} CI:1.31–1.44) as compared to those untreated/treatment status unknown (SIR 1.16, 95{\%} CI:1.13–1.19, p < 0.001). In a multivariate analysis, the hazard of developing SPMs was higher among men, post-chemotherapy, recent years of diagnosis, advanced age, and non-Whites. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL.",
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AU - Biswas, Suman

AU - Sher, Taimur

AU - Roy, Vivek

AU - Vishnu, Prakash

AU - Marin-Acevedo, Julian

AU - Alegria, Victoria R.

AU - Paulus, Aneel

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AU - Iqbal, Madiha

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