Second cancers in patients with chronic lymphocytic leukemia who received frontline fludarabine, cyclophosphamide and rituximab therapy: distribution and clinical outcomes.

Abstract

Patients with chronic lymphocytic leukemia (CLL) are known to have an increased incidence of second cancers, but the contribution of commonly used frontline therapies to the incidence of second cancers is unclear. We report on the characteristics, incidence, outcomes and factors associated with second cancers in 234 patients receiving fludarabine, cyclophosphamide and rituximab (FCR) based regimens in the frontline setting. The risk of second cancers was 2.38 times higher than the expected risk in the general population. Ninety-three patients (40%) had other cancers before and 66 patients (28%) after FCR. Rates of therapy related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) (5.1%) and Richter transformation (RT) (9%) were high, while solid tumors were not increased. Overall survival of patients with second cancers after frontline FCR was shorter (median of 4.5 years) compared to patients with and without prior cancers. Second cancer risk after frontline FCR is mainly due to high rates of t-AML/MDS and RT, and as speculated the survival of affected patients is shorter.

• Authors: Ohad Benjamini, Preetesh Jain, Long Trinh, Wei Qiao, Sara S Strom, Susan Lerner, Xuemei Wang, Jan Burger, Alessandra Ferrajoli, Hagop Kantarjian, Susan O'Brien, William Wierda, Zeev Estrov, Michael Keating
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 56 Issue 6 Pg. 1643-50 (Jun 2015) ISSN: 1029-2403 [Electronic] United States
• PMID: 25308294 (Publication Type: Journal Article)

Chemical References

• Rituximab
• Cyclophosphamide
• Vidarabine
• fludarabine

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Cell Transformation, Neoplastic (chemically induced)
• Cyclophosphamide (administration & dosage)
• Female
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy)
• Leukemia, Myeloid, Acute (chemically induced, epidemiology)
• Male
• Middle Aged
• Myelodysplastic Syndromes (chemically induced, epidemiology)
• Neoplasms, Second Primary (chemically induced, epidemiology)
• Retrospective Studies
• Risk Factors
• Rituximab (administration & dosage)
• Survival Rate
• Vidarabine (administration & dosage, analogs & derivatives)