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Waldenström’s macroglobulinemia increases risk for secondary malignancies
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Patients with Waldenström’s macroglobulinemia demonstrated an increased risk for secondary malignancies compared with the general population, according to study results.
“Based on our previous research, patients with Waldenström’s macroglobulinemia are living longer with a lower rate of mortality for Waldenström’s macroglobulinemia-related causes,” Jorge J. Castillo, MD, of the Bing Center for Waldenström’s Macroglobulinemia at Dana-Farber Cancer Institute, told HemOnc Today. “Therefore, questions arise about other causes of death in patients with Waldenström’s macroglobulinemia. Our research was motivated by our curiosity in this regard.”
Jorge J. Castillo
Castillo and colleagues used the SEER-13 database to identify 4,676 patients with Waldenström’s macroglobulinemia. The median age of the population was 71 years (range, 61-79) and 58% were male.
Researchers determined 608 patients developed 681 secondary malignancies. The median time from Waldenström’s macroglobulinemia diagnosis to diagnosis of a secondary malignancy was 3.7 years.
The 5-year cumulative incidence of secondary malignancies was 9.5% (95% CI, 8.6-10.5) and the 10-year incidence was 16.1% (95% CI, 14.8-17.3). The cumulative incidence was higher for solid tumors than hematologic malignancies at 5 years (7.3% vs. 2.3%) and 10 years (12.2% vs. 4.2%).
Researchers then compared these results with data from an age-matched cohort from the general U.S. population. Patients with Waldenström’s macroglobulinemia demonstrated a 49% increased risk for the development of a secondary malignancy compared with the general population (multiple primary standardized incidence ratio [MP-SIR] = 1.49; 95% CI, 1.38-1.61).
Patients with Waldenström’s macroglobulinemia demonstrated significantly increased risks for all lymphomas (MP-SIR = 4.38), multiple myeloma (MP-SIR = 4.68), acute leukemia (MP-SIR = 3.19), lung cancer (MP-SIR = 1.48), urinary tract cancer (MP-SIR = 1.41), melanoma (MP-SIR = 1.94) and thyroid cancer (MP-SIR = 2.67).
“Patients with Waldenström’s macroglobulinemia have a higher risk for developing second cancers, specifically thyroid cancer, lung cancer and urinary tract cancer,” Castillo said. “This risk could be attributed to immune dysregulation, environmental exposures and/or genetic predisposition. Patients also have a higher risk of developing aggressive lymphoma, myelodysplasia and acute leukemia, which are most likely associated with prior therapy, specifically with nucleoside analogues and alkylating agents.”
The risk for a secondary malignancy was significantly higher for patients aged younger than 65 years vs. those aged 65 years or older (MP-SIR = 2.24 vs. 1.37). Men and women displayed a similarly increased risk for solid tumors, although women demonstrated a significantly higher risk for hematologic malignancies, specifically with regard to lymphoma and myeloma (MP-SIR = 5.82 vs. 3.43).
The risk for secondary malignancies did not significantly differ according to patients’ race or year of diagnosis.
“As patients with Waldenström’s macroglobulinemia live longer, we are strongly advocating for patients to follow age-appropriate cancer screening and yearly skin surveys,” Castillo said.
The results of this analysis have opened many more research questions on the topic, he added.
“We are currently evaluating the outcomes of patients with Waldenström’s macroglobulinemia who develop other cancers,” Castillo said. “Patients with Waldenström’s macroglobulinemia have a higher risk for developing other cancers, but how do they fare once they are diagnosed with those cancers in comparison with the general population? Is the survival shorter? How are they treated? Those aspects have not been previously investigated.” – by Cameron Kelsall
For more information:
Jorge J. Castillo, MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., M221, Boston, MA 02215; email: jorgej_castillo@dfci.harvard.edu.
Disclosures: Castillo reports no relevant financial disclosures. One author reports consultant roles with Janssen Pharmaceuticals, Onyx and Pharmacyclics.
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