Secondary malignancies among mantle cell lymphoma patients
(2023) In European Journal of Cancer 195.- Abstract
Purpose: With modern treatments, mantle cell lymphoma (MCL) patients more frequently experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late-effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients. Methods: All patients with a primary diagnosis of MCL, aged ≥ 18 years and diagnosed between 2000 and 2017 in Sweden were included along with up to 10 individually matched population comparators. Follow-up was from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and... (More)
Purpose: With modern treatments, mantle cell lymphoma (MCL) patients more frequently experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late-effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients. Methods: All patients with a primary diagnosis of MCL, aged ≥ 18 years and diagnosed between 2000 and 2017 in Sweden were included along with up to 10 individually matched population comparators. Follow-up was from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and comparators were estimated using the Anderson-Gill method (accounting for repeated events) and presented as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age at diagnosis, calendar year, sex, and the number of previous events. Results: Overall, 1 452 patients and 13 992 comparators were followed for 6.6 years on average. Among patients, 230 (16%) developed at least one SM, and 264 SM were observed. Relative to comparators, patients had a higher rate of SM, HRadj= 1.6 (95%CI:1.4–1.8), and higher rates were observed across all primary treatment groups: the Nordic-MCL2 protocol, R-CHOP, R-bendamustine, ibrutinib, lenalidomide, and R-CHOP/Cytarabine. Compared to Nordic-MCL2, treatment with R-bendamustine was independently associated with an increased risk of SM, HRadj= 2.0 (95%CI:1.3–3.2). Risk groups among patients were those with a higher age at diagnosis (p < 0.001), males (p = 0.006), and having a family history of lymphoma (p = 0.009). Patients had preferably higher risk of melanoma, other neoplasms of the skin and other hematopoietic and lymphoid malignancies. Conclusions: MCL survivors have an increased risk of SM, particularly if treated with R-bendamustine. The intensive treatments needed for long-term remissions are a concern, and transition to treatment protocols with sustained efficacy but with a lower risk of SM is needed.
(Less)
- author
- Abalo, Kossi D. ; Smedby, Karin E. ; Ekberg, Sara LU ; Eloranta, Sandra ; Pahnke, Simon ; Albertsson-Lindblad, Alexandra LU ; Jerkeman, Mats LU and Glimelius, Ingrid
- organization
- publishing date
- 2023-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Ibrutinib, Lenalidomide, Mantle cell lymphoma, Nordic-MCL2, R-bendamustine, R-CHOP, R-CHOP/Cytarabine, Secondary malignancy
- in
- European Journal of Cancer
- volume
- 195
- article number
- 113403
- publisher
- Elsevier
- external identifiers
-
- pmid:37952281
- scopus:85176229759
- ISSN
- 0959-8049
- DOI
- 10.1016/j.ejca.2023.113403
- language
- English
- LU publication?
- yes
- id
- 8261b5b0-3f5f-46d6-b2f3-2b2d3c32f014
- date added to LUP
- 2024-01-05 12:47:54
- date last changed
- 2024-04-20 09:08:41
@article{8261b5b0-3f5f-46d6-b2f3-2b2d3c32f014,
abstract = {{<p>Purpose: With modern treatments, mantle cell lymphoma (MCL) patients more frequently experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late-effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients. Methods: All patients with a primary diagnosis of MCL, aged ≥ 18 years and diagnosed between 2000 and 2017 in Sweden were included along with up to 10 individually matched population comparators. Follow-up was from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and comparators were estimated using the Anderson-Gill method (accounting for repeated events) and presented as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age at diagnosis, calendar year, sex, and the number of previous events. Results: Overall, 1 452 patients and 13 992 comparators were followed for 6.6 years on average. Among patients, 230 (16%) developed at least one SM, and 264 SM were observed. Relative to comparators, patients had a higher rate of SM, HR<sub>adj</sub>= 1.6 (95%CI:1.4–1.8), and higher rates were observed across all primary treatment groups: the Nordic-MCL2 protocol, R-CHOP, R-bendamustine, ibrutinib, lenalidomide, and R-CHOP/Cytarabine. Compared to Nordic-MCL2, treatment with R-bendamustine was independently associated with an increased risk of SM, HR<sub>adj</sub>= 2.0 (95%CI:1.3–3.2). Risk groups among patients were those with a higher age at diagnosis (p < 0.001), males (p = 0.006), and having a family history of lymphoma (p = 0.009). Patients had preferably higher risk of melanoma, other neoplasms of the skin and other hematopoietic and lymphoid malignancies. Conclusions: MCL survivors have an increased risk of SM, particularly if treated with R-bendamustine. The intensive treatments needed for long-term remissions are a concern, and transition to treatment protocols with sustained efficacy but with a lower risk of SM is needed.</p>}},
author = {{Abalo, Kossi D. and Smedby, Karin E. and Ekberg, Sara and Eloranta, Sandra and Pahnke, Simon and Albertsson-Lindblad, Alexandra and Jerkeman, Mats and Glimelius, Ingrid}},
issn = {{0959-8049}},
keywords = {{Ibrutinib; Lenalidomide; Mantle cell lymphoma; Nordic-MCL2; R-bendamustine; R-CHOP; R-CHOP/Cytarabine; Secondary malignancy}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{European Journal of Cancer}},
title = {{Secondary malignancies among mantle cell lymphoma patients}},
url = {{http://dx.doi.org/10.1016/j.ejca.2023.113403}},
doi = {{10.1016/j.ejca.2023.113403}},
volume = {{195}},
year = {{2023}},
}