Treatment-specific risk of subsequent malignant neoplasms in five-year survivors of diffuse large B-cell lymphoma.

Autor:	Geurts YM; Department of Epidemiology, Netherlands Cancer Institute, Amsterdam., Neppelenbroek SIM; Department of Epidemiology, Netherlands Cancer Institute, Amsterdam., Aleman BMP; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam., Janus CPM; Department of Radiotherapy, Erasmus Medical Centre, Rotterdam., Krol ADG; Department of Radiation Oncology, Leiden University Medical Centre, Leiden., van Spronsen DJ; Department of Hematology, Radboud University Medical Centre, Nijmegen., Plattel WJ; Department of Hematology, University Medical Centre Groningen, Groningen., Roesink JM; Department of Radiotherapy, University Medical Centre Utrecht, Utrecht., Verschueren KMS; Department of Radiation Oncology, Institute Verbeeten, Tilburg., Zijlstra JM; Department of Hematology, Amsterdam UMC location Vrije Universiteit, Cancer Centre Amsterdam, Amsterdam., Koene HR; Department of Internal Medicine, St. Antonius Hospital, Nieuwegein., Nijziel MR; Catharina Cancer Institute, Department of Hemato-Oncology, Catharina Hospital, Eindhoven., Schimmel EC; Radiotherapiegroep, Arnhem., de Jongh E; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht., Ong F; Department of Radiotherapy, Medisch Spectrum Twente, Enschede., Te Boome LCJ; Department of Hematology, Haaglanden Medical Centre, The Hague., van Rijn RS; Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden., Böhmer LH; Department of Hematology, Haga Teaching Hospital, The Hague., Ta BDP; Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht., Visser HPJ; Department of Hematology, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar., Posthuma EFM; Department of Internal Medicine, Reinier de Graaf Hospital, Delft., Bilgin YM; Department of Internal Medicine, ADRZ, Goes., Muller K; Radiotherapiegroep, Deventer., van Kampen D; Zuidwest Radiotherapeutisch Instituut, Vlissingen., So-Osman C; Department of Hematology, Erasmus Medical Centre, Rotterdam; Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam., Vermaat JSP; Department of Hematology, Leiden University Medical Centre, Leiden., de Weijer RJ; Department of Hematology, University Medical Centre Utrecht, Utrecht., Kersten MJ; Department of Hematology, Amsterdam UMC location University of Amsterdam, Cancer Centre Amsterdam and LYMMCARE, Amsterdam, The Netherlands., van Leeuwen FE; Department of Epidemiology, Netherlands Cancer Institute, Amsterdam., Schaapveld M; Department of Epidemiology, Netherlands Cancer Institute, Amsterdam. Electronic address: m.schaapveld@nki.nl.
Jazyk:	angličtina
Zdroj:	ESMO open [ESMO Open] 2024 Feb; Vol. 9 (2), pp. 102248. Date of Electronic Publication: 2024 Feb 12.
DOI:	10.1016/j.esmoop.2024.102248
Abstrakt:	Background: The introduction of rituximab significantly improved the prognosis of diffuse large B-cell lymphoma (DLBCL), emphasizing the importance of evaluating the long-term consequences of exposure to radiotherapy, alkylating agents and anthracycline-containing (immuno)chemotherapy among DLBCL survivors. Methods: Long-term risk of subsequent malignant neoplasms (SMNs) was examined in a multicenter cohort comprising 2373 5-year DLBCL survivors treated at ages 15-61 years in 1989-2012. Observed SMN numbers were compared with expected cancer incidence to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10 000 person-years). Treatment-specific risks were assessed using multivariable Cox regression. Results: After a median follow-up of 13.8 years, 321 survivors developed one or more SMNs (SIR 1.5, 95% CI 1.3-1.8, AER 51.8). SIRs remained increased for at least 20 years after first-line treatment (SIR ≥20-year follow-up 1.5, 95% CI 1.0-2.2, AER 81.8) and were highest among patients ≤40 years at first DLBCL treatment (SIR 2.7, 95% CI 2.0-3.5). Lung (SIR 2.0, 95% CI 1.5-2.7, AER 13.4) and gastrointestinal cancers (SIR 1.5, 95% CI 1.2-2.0, AER 11.8) accounted for the largest excess risks. Treatment with >4500 mg/m 2 cyclophosphamide/>300 mg/m 2 doxorubicin versus ≤2250 mg/m 2 /≤150 mg/m 2 , respectively, was associated with increased solid SMN risk (hazard ratio 1.5, 95% CI 1.0-2.2). Survivors who received rituximab had a lower risk of subdiaphragmatic solid SMNs (hazard ratio 0.5, 95% CI 0.3-1.0) compared with survivors who did not receive rituximab. Conclusion: Five-year DLBCL survivors have an increased risk of SMNs. Risks were higher for survivors ≤40 years at first treatment and survivors treated with >4500 mg/m 2 cyclophosphamide/>300 mg/m 2 doxorubicin, and may be lower for survivors treated in the rituximab era, emphasizing the need for studies with longer follow-up for rituximab-treated patients. Competing Interests: Disclosure MJK has received research support from Kite/Gilead and financial compensation for attending advisory boards and/or presentations from Roche, Kite/Gilead, Novartis, BMS/Celgene, Miltenyi Biotec, Takeda and Adicet Bio. All other authors have declared no conflicts of interest. (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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