Second malignancies as a consequence of nucleoside analog therapy for chronic lymphoid leukemias
Second malignancies as a consequence of nucleoside analog therapy for chronic lymphoid leukemias
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DOI：
10.1200/jco.1999.17.8.2454
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发表时间：
1999-08-01
影响因子：
45.3
通讯作者：
Freidlin, B
中科院分区：
文献类型：
--
作者：
Cheson, BD;Vena, DA;Freidlin, B
目的：核苷类似物氟达拉滨、2'-脱氧福霉素 (DCF) 和 2-氯脱氧腺苷 (CdA) 常用于治疗慢性淋巴细胞白血病 (CLL) 和毛细胞白血病 (HCL) 等惰性淋巴恶性肿瘤患者，与骨髓抑制相关，并导致严重且持久的骨髓抑制。 免疫抑制。这些并发症增加了患有继发性恶性肿瘤的可能性，这些患者的疾病已经使他们面临更大的风险。本研究的目的是评估接受氟达拉滨治疗的 CLL 患者以及接受 DCF 和 CdA 治疗的 HCL 患者第二肿瘤的发生率。 患者和方法：我们使用第二份癌症报告回顾了 2,014 名接受国家癌症研究所 C 组方案治疗复发和难治性 CLL 的 CLL 患者以及 DCF 和 CdA 治疗 HCL 的患者的长期随访数据。比较观察到的和预期的继发性肿瘤的数量。结果：DCF (n = 409)、氟达拉滨 (n = 724) 和 CdA (n = 979) 研究的中位随访期分别为 6.9、7.4 和 5.1 年。这 111 种恶性肿瘤中最常见的是淋巴瘤（25 例）、前列腺癌（19 例）、肺癌（15 例）、结直肠癌（9 例）、膀胱癌（6 例）和乳腺癌（6 例），但也有中枢神经系统癌、胃癌、卵巢癌、头颈癌、黑色素瘤、肉瘤、睾丸癌和骨髓性白血病。与一般人群经年龄调整的 1994 年监测和流行病学最终结果率相比，DCF、氟达拉滨和 CdA 的观察/预期频率分别为 1.43（95% 置信区间 [CI]，0.93 至 2.10）、1.65（95% CI，1.04 至 2.47）和 1.50（95% CI， 1.14至1.93）分别， 表明与正常人群相比，接受后两种方案治疗的患者的风险显着增加（P = .05）。然而，这些值与这些疾病相关的增加是一致的。结论：尽管核苷类似物具有免疫抑制作用，但核苷类似物可以安全地用于 CLL 或 HCL 患者，而不会显着增加继发性恶性肿瘤的风险。 (C) 1999 年，美国临床肿瘤学会。
Purpose: The nucleoside analogs fludarabine, 2'-deoxycoformycin (DCF), and 2-chlorodeoxyadenosine (CdA), commonly used in the treatment of patients with indolent lymphoid malignancies such as chronic lymphocytic leukemia (CLL) and hairy cell leukemia (HCL), are associated with myelosuppression and profound and prolonged immunosuppression. These complications raise the possibility of an increase in secondary malignancies in patients whose disease already places them at greater risk. The purpose of the present study was to assess the frequency of second tumors in patients with CLL who are treated with fludarabine and in patients with HCL who are treated with DCF and CdA.Patients and Methods: We reviewed the long-term follow-up data for 2,014 patients treated on National Cancer Institute Group C protocols with fludarabine for relapsed and refractory CLL and with DCF and CdA for HCL using a Second Cancer Report. The numbers of observed and expected secondary tumors were compared.Results: Median follow-vp periods for the DCF (n = 409), fludarabine (n = 724), and CdA (n = 979) studies were 6.9, 7.4, and 5.1 years, respectively. The 111 malignancies were most commonly lymphoma (25 patients), prostate (19), lung (15), colorectal (nine), bladder (six), and breast (six), but also CNS, stomach, ovary, head and neck, melanoma, sarcoma, testicular, and myeloid leukemias. Compared with age-adjusted 1994 Surveillance and Epidemiology End-Results rates for the general population, the observed/expected frequencies for DCF, fludarabine, and CdA were 1.43 (95% confidence interval [CI], 0.93 to 2.10), 1.65 (95% CI, 1.04 to 2.47), and 1.50 (95% CI, 1.14 to 1.93), respectively, indicating a significant (at P = .05) increase in risk for patients treated on the latter two protocols compared with a normal population. However, these values are consistent with the increase already associated with these diseases.Conclusion: Despite their immunosuppression, nucleoside analogs can be safely administered to patients with CLL or HCL without a significantly increased risk of secondary malignancies. (C) 1999 by American Society of Clinical Oncology.