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Genetic, immunologic patterns may offer insight into second malignancy etiologies

Morton LM. J Clin Oncol. 2010;28:4935-4944.

Issue: January 2011

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Second malignancies occurred in heterogeneous patterns that depended on lymphoma subtype, according to recent study results.

Researchers from several sites in the US sought to quantify risk for a second malignancy by lymphoma subtype. They evaluated 43,145 patients who had non-Hodgkin’s lymphoma and chronic lymphocytic leukemia.

Eligible patients were 1-year survivors of CLL, small lymphocytic lymphoma (SLL), diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma from 11 SEER population-based registries from 1992 to 2006.

There were 49 patients with HIV/AIDS-related DLBCL who had second malignancies, resulting in an SIR of 3.81 (95% CI, 2.82-5.03). These patients also were at an increased risk for second anal cancer (SIR=120.5) and Kaposi’s sarcoma (SIR=138.9).

Among patients who did not have HIV/AIDS–related lymphoma, the standardized incidence ratios for lung cancer risk were 1.42 for CLL/SLL, 1.28 for follicular lymphoma and 1.0 for DLBCL. Patients diagnosed younger than 55 years were at approximately a twofold risk for CLL/SLL (SIR=2.32) and follicular lymphoma (SIR=2.01).

The risk for cutaneous melanoma showed a similar trend (SIR: CLL/SLL=1.92; follicular lymphoma=1.6; DLBCL=1.06). Patients diagnosed at younger than 70 years were at increased risk, as were patients who had melanomas on sun-exposed areas such as the face, head, neck and limbs. Patients with melanomas 1 mm to 3.9 mm thick had an SIR of 2.57; the ratio was 3.3 for patients with melanomas of at least 4 mm.

The SIR for acute nonlymphocytic leukemia risk was 1.13 for CLL/SLL, 5.96 for follicular lymphoma and 4.96 for DLBCL.

The risk for Hodgkin’s lymphoma after CLL/SLL yielded an SIR of 15.11; the ratio for Hodgkin’s lymphoma risk was 9.02 after DLBCL and 6.78 after follicular lymphoma. Patients diagnosed with CLL/SLL aged younger than 70 years were at a risk of more than 20-fold for Hodgkin’s lymphoma.

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