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Inferior OS found in certain patients with pre-existing CLL
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Patients with cancers of the breast, colorectum, kidney, prostate or lung exhibited inferior OS if they had a pre-existing diagnosis of chronic lymphocytic leukemia, according to study results.
Previous studies have indicated an association between CLL and an increased patient risk for secondary cancers, including lung, breast, colon, head and neck, kidney, bladder, prostate, thyroid, melanoma and nonmelanomas, as well as Hodgkin’s and non-Hodgkin’s lymphomas. However, few studies evaluated the disease course of secondary malignancies in patients with CLL.
“Recent population-based data also suggest that melanoma may behave more aggressively in individuals with CLL, raising the possibility that the presence of CLL not only influences the risk of developing solid tumors but may be associated with more aggressive behavior once they occur,” Benjamin M. Solomon, MD, and colleagues from the Mayo Clinic in Rochester, Minn., wrote. “If true, this observation could have important repercussions for patient counseling and disease management.”
To determine whether the incidence of CLL modified the disease course of common carcinomas, Solomon and colleagues used the SEER database to conduct a population-based analysis of survival in patients with common cancers, including breast (n=579,164), colorectum (n=412,366), lung (n=489,053), prostate (n=631,616), kidney (n=95,795), ovary (n=61,937) and pancreas (n=82,116).
Patients with a CLL diagnosis date before or within 3 months after the second cancer diagnosis date were considered to have pre-existent CLL and were included in the cohort. Patients with a CLL diagnosis 4 or more months after the cancer diagnosis date were excluded.
According to study results, patients with breast (HR=1.70; P<.001), colorectum (HR=1.65; P<001), kidney (HR=1.54; P< .001), prostate (HR=1.92; P<.001) or lung cancers (HR=1.19; P<.001) exhibited inferior OS if they had a pre-existing diagnosis of CLL.
In addition, cancer-specific survival was inferior for patients with breast (HR=1.41; P=.005) and colorectum cancers (HR=1.46; P<.001) who had pre-existing CLL.
“This analysis provides evidence for shorter cancer-specific survival for patients with colorectal and breast cancers who have pre-existent CLL,” Solomon and colleagues wrote. “This finding may have prognostic importance and influence counseling, decision making and management of these patients. Fit patients with CLL should be offered standard treatments for other malignancies because CLL can often follow an indolent disease course. Basic and translational studies exploring the possible mechanisms underlying the inferior cancer-specific outcomes in patients with CLL, as well as additional efforts to determine the optimal management of these malignancies in patients with CLL, are needed.”
Disclosure: The researchers report no relevant financial disclosures.
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Harry S. Jacob, MD, FRCPath(Hon)
Not all together surprising if one accepts the truism that immunocompetence — not a signature feature of CLL — inhibits carcinogenic response.
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