Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma: a Swedish population-based study.
Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma: a Swedish population-based study.
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DOI：
10.1182/bloodadvances.2021006369
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发表时间：
2022-04-26
期刊：
影响因子：
7.5
通讯作者：
Eloranta, Sandra
中科院分区：
文献类型：
--
作者：
Joelsson, Joel;Wasterlid, Tove;Rosenquist, Richard;Jakobsen, Lasse Hjort;El-Galaly, Tarec C.;Smedby, Karin E.;Eloranta, Sandra
我们观察到，与一般人群相比，淋巴瘤患者的继发性恶性肿瘤随时间推移的超额率稳定。在滤泡性淋巴瘤中，继发性骨髓增生异常综合征和急性髓性白血病的发病率在 2009 年之后出现下降。考虑到非霍奇金淋巴瘤 (NHL) 随着时间的推移治疗方法的变化和预后的改善，有关长期健康结果（包括治疗的后期影响）的知识变得越来越重要。我们报告了瑞典 NHL 患者第二原发恶性肿瘤 (SPM) 的时间趋势，涵盖引入抗 CD20 抗体疗法之前和之后的几年。我们在 1993 年至 2014 年瑞典癌症登记册中确定了 NHL 患者，并从瑞典总人口登记册中匹配了对照者。对匹配的队列进行了整个 2017 年的随访。通过链接到瑞典淋巴瘤登记库，按 NHL 亚型进行了亚队列分析。使用灵活的参数生存模型来估计患者和比较者之间 SPM 的 95% 置信区间 (CI) 的风险比 (HR)。在 32-100 名 NHL 患者中，观察到 3619 例实体瘤和 217 例骨髓增生异常综合征 (MDS)/急性髓性白血病 (AML) 病例，实体瘤发生率高出 40%（HR 实体瘤 = 1.4；95% CI，1.4-1.5），MDS/AML 发生率高出 5 倍（HRMDS/AML = 5.2；HRMDS/AML = 5.2；95% CI，1.4-1.5）。 95% CI, 4.4-6.2) 比比较器高。总体而言，在研究期间观察到的实体瘤或 MDS/AML 的超额风险保持稳定，但滤泡性淋巴瘤除外，其中 MDS/AML 的超额风险随着时间的推移而减弱（趋势 P = 0.012）。我们得出的结论是，NHL 幸存者患实体瘤和血液恶性肿瘤（尤其是 MDS/AML）的风险增加。随着时间的推移，稳定的超额风险表明当代治疗标准与修改后的 SPM 风险无关。令人鼓舞的是，滤泡性淋巴瘤患者的 MDS/AML 发病率有所下降，这可能是由于越来越多地使用非化疗治疗所致。
We observed stable excess rates of secondary malignancies over time among lymphoma patients compared with the general population. In follicular lymphoma, decreasing rates of secondary myelodysplastic syndrome and acute myeloid leukemia were observed after 2009. Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes, including late effects of treatment, has become increasingly important. We report on time trends of second primary malignancies (SPMs) in Swedish NHL patients, encompassing the years before as well as after the introduction of anti-CD20 antibody therapy. We identified NHL patients in the Swedish Cancer Register 1993 to 2014 and matched comparators from the Swedish Total Population Register. The matched cohort was followed through 2017. By linking to the Swedish Lymphoma Register, subcohort analyses by NHL subtype were performed. Flexible parametric survival models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of SPM among patients and comparators. Among 32 100 NHL patients, 3619 solid tumors and 217 myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) cases were observed, corresponding to a 40% higher rate of solid tumors (HRsolid tumors = 1.4; 95% CI, 1.4-1.5) and a 5-fold higher rate of MDS/AML (HRMDS/AML = 5.2; 95% CI, 4.4-6.2) than for comparators. Overall, the observed excess risks for solid tumors or MDS/AML remained stable over the study period, except for follicular lymphoma, where the excess rate of MDS/AML attenuated with time (P for trend = .012). We conclude that NHL survivors have an increased risk of both solid tumors and hematologic malignancies, in particular MDS/AML. Stable excess risks over time indicate that contemporary treatment standards are not associated with modified SPM risk. Encouragingly, decreasing rates of MDS/AML were noted among patients with follicular lymphoma, possibly due to the increasing use of nonchemotherapy-based treatments.
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影响因子：
6.5
作者：
Tao L;Clarke CA;Rosenberg AS;Advani RH;Jonas BA;Flowers CR;Keegan THM
通讯作者：
Keegan THM
影响因子：
3.3
作者：
Tadmor, Tamar;Liphshitz, Irena;Polliack, Aaron
通讯作者：
Polliack, Aaron
影响因子：
8.4
作者：
Serraino, Diego;Piselli, Pierluca;Franceschi, Silvia
通讯作者：
Franceschi, Silvia
影响因子：
2
作者：
Royston, P;Parmar, MKB
通讯作者：
Parmar, MKB
影响因子：
50.5
作者：
Pirani, M.;Marcheselli, R.;Sacchi, S.
通讯作者：
Sacchi, S.