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Autoimmune conditions, infections common among diffuse large B-cell lymphoma survivors
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ATLANTA — Adults with diffuse large B-cell lymphoma had increased risk for developing autoimmune and infectious diseases within 10 years from diagnosis compared with breast and prostate cancer survivors, according to findings from a population-based study presented at the ASH Annual Meeting and Exposition.
Improved survival rates have led to an increasing number of DLBCL survivors, who may experience immune perturbations from treatment. Despite this, research on mid- and long-term immune health remains scarce.
“Late effects known to be suffered by lymphoma survivors include cardiovascular effects, pulmonary effects, psychological effects, infertility and secondary cancers,” Tanaya Shree, MD, PhD, clinical fellow in the department of medicine, division of oncology, at Stanford University Medical Center, said during her presentation. “We know most of the treatments we give have indirect or direct effects on the immune system, so our question is how does the immune system favor during survivorship?”
Shree and colleagues evaluated whether DLBCL survivors have modified risk for developing autoimmune and infectious diseases compared with other cancer survivors.
Researchers identified 21,690 adults from the California Cancer Registry diagnosed with DLBCL between 1991 and 2012 and followed in California hospital, ED and ambulatory surgery discharge databases through 2014.
Each patient survived a minimum of 1 year from diagnosis and had no evidence of HIV or AIDS. Researchers excluded conditions identified prior to or within 1 year of cancer diagnosis from the incidence analyses to avoid possible relationships to lymphoma pathogenesis.
Researchers adjusted analyses for age, race, ethnicity and year of cancer diagnosis to calculate incidence of autoimmune and infectious diseases among survivors of DLBCL compared with breast and prostate cancer survivors 1 and 10 years out from cancer diagnosis.
Median follow-up was longer for female breast cancer survivors (8.2 years) and male prostate cancer survivors (8.3 years) than survivors of DLBCL (female, 6.3 years; male, 5.9 years).
At least one hospitalization occurred among 67.9% of patients with DLBCL prior to or within 1 year of diagnoses, and among 78.6% of survivors between 1 and 10 years from diagnosis.
A higher cumulative incidence of any infectious disease 1 to 10 years from cancer diagnosis occurred among DLBCL survivors (women, 40%; men, 38%) than among breast (25%) or prostate cancer (35%) survivors.
Researchers also observed a higher cumulative incidence of any autoimmune disease 1 to 10 years from cancer diagnosis among DLBCL survivors (women, 10%; men, 8%) than among breast (7%) or prostate cancer (5%) survivors.
For diagnoses of infections, DLBCL survivors had a more than twofold higher incidence of fungal pneumonia (incidence rate ratio [IRR] vs. breast = 6.2; IRR vs. prostate = 8.2), viral pneumonia (IRR vs. breast = 3.4; IRR vs. prostate = 4.5), bacteremia (IRR vs. breast = 2.6; IRR vs. prostate = 3.1) and central nervous system infections (IRR vs. breast = 2.6; IRR vs. prostate = 3.2; P < .0001 for all).
Male DLBCL survivors had higher incidence of liver abscesses (IRR = 3), empyema (IRR = 2.4), bacterial pneumonias (IRR = 2.1) and infections of implanted devices (IRR = 2.1) than prostate cancer survivors.
For autoimmune diagnoses, DLBCL survivors had higher incidence of autoimmune hemolytic anemia (IRR vs. breast = 10.1; IRR vs. prostate = 8.7), immune thrombocytopenia (IRR vs. breast = 3.1; IRR vs. prostate = 4.7) and diffuse connective tissue diseases (IRR vs. breast = 2.1; IRR vs. prostate = 2.5; P < .0001 for all).
Researchers observed an increase in acquired coagulation factor deficiencies (IRR = 2.1) caused by autoimmunity against clotting factors among DLBCL survivors compared with prostate cancer survivors.
DLBCL survivors had increased incidence of impaired humoral immunity diagnosis (IRR vs. breast = 16; IRR vs. prostate = 14).
“These findings in a large, population-based study suggest that compared with survivors of other common cancers, DLBCL survivors experience excess immune-related conditions, some expected, and others unexpected,” Shree said. “This information suggests possible lasting effects of lymphoma and its treatments on the immune system and motivates further examination of immune function in DLBCL survivors.” – by Melinda Stevens
Reference:
Shree T, et al. Abstract 198. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.
Disclosures : The authors report no relevant financial disclosures.