Other Malignancies in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

December 30, 2008

JCO Early Release, published online ahead of print Dec 29 2008

Journal of Clinical Oncology, 10.1200/JCO.2008.17.5398

Apostolia- Tsimberidou,* Sijin Wen, McLaughlin, O'Brien,

G. Wierda, Lerner, Sara Strom, Emil J. Freireich, L.

Medeiros, Hagop M. Kantarjian, and J. Keating

From the Departments of Leukemia, Biostatistics, Lymphoma and Myeloma,

Epidemiology, and Hematopathology, The University of Texas M. D. Cancer

Center, Houston, TX.

* To whom correspondence should be addressed. E-mail: atsimber@...

Purpose: Other malignancies have been reported to occur with increased frequency

in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The aim of

this study was to determine the frequency, outcomes, and factors associated with

other cancers in patients with CLL/SLL.

Patients and Methods: We reviewed the records of consecutive patients with

previously untreated CLL/SLL seen at The University of Texas M. D.

Cancer Center from 1985 to 2005. The number of second cancers observed was

compared with the number expected from the Surveillance, Epidemiology, and End

Results database.

Results: Among 2,028 patients, 324 (16%) had a history of other cancers and 227

(11.2%) developed other malignancies during the follow-up period. Overall, 625

cancers were observed in 551 patients, including skin (30%), prostate (13%),

breast (9%), melanoma (8%), lymphoma (8%), gastrointestinal (9%), lung (6%), and

other cancers (17%). The risk of a second cancer was 2.2 times higher than the

expected risk. The response rates in patients with and without a history of

other cancers were 86% and 92%, respectively (P = .04), and the 5-year survival

rates were 70% and 82%, respectively (P < .001). In analysis, independent

factors predicting development of new cancers were older age, male sex, and

elevated levels of 2-microglobulin, lactate dehydrogenase, and creatinine. In

patients who were treated for CLL/SLL, the treatment regimen did not affect the

risk of subsequent cancer (P = .49).

Conclusion: Patients with CLL/SLL have more than twice the risk of developing a

second cancer and an increased frequency of certain cancer types. Awareness of

risk factors could permit early detection.

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