Risk for second malignancies in non-Hodgkin’s lymphoma survivors: a meta-analysis

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BlankRisk for second malignancies in non-Hodgkin’s lymphoma survivors: a

meta-analysis

1.. M. Pirani,

2.. R. Marcheselli,

3.. L. Marcheselli,

4.. A. Bari,

5.. M. Federico and

6.. S. Sacchi

+ Author Affiliations

1.. Department of Oncology and Hematology, University of Modena and Reggio

Emilia, Modena, Italy

1.. *Correspondence to: Dr R. Marcheselli, Department of Oncology and

Hematology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124

Modena, Italy. Tel: +39-059-4222175; Fax: +39-059-4224152; E-mail:

raffaella.marches

a.. Received September 9, 2010.

b.. Received October 29, 2010.

c.. Accepted November 2, 2010.

Abstract

Background: Late side-effects are becoming an important issue in non-Hodgkin’s

lymphoma (NHL) survivors. We intended to estimate pooled relative risk (RR) of

secondary malignant neoplasms (SMNs), to evaluate site-associated RR and the

impact of different treatments.

Design: We carried out an electronic search of Medline and EMBASE seeking

articles investigating the risk of SMNs and reporting RR measures. The studies

were evaluated for heterogeneity before meta-analysis and for publication bias.

Pooled RRs were estimated using fixed- and random-effects models.

Results: A total of 23 studies met the inclusion criteria. Pooled RRs of SMNs

overall and for solid tumors were 1.88 and 1.32, respectively. We found an

excess of risk for several specific cancer sites. Radiotherapy alone did not

increase the risk for SMNs, while chemotherapy and combined treatments augmented

the RR. Regression analyses revealed a positive significant association for all

SMNs with total body irradiation, and for solid SMNs with younger age. No

publication bias was observed.

Conclusions: Our results indicate that NHL patients experience a higher risk for

SMNs than the general population and that various treatments have different

impact on RR. More information will be necessary to evaluate possible

interactions with genetic susceptibility and environmental exposure.