Subsequent primary malignancies after diffuse large B-cell lymphoma in the modern treatment era.
Subsequent primary malignancies after diffuse large B-cell lymphoma in the modern treatment era.
复制标题
DOI：
10.1111/bjh.14638
复制
发表时间：
2017-07
影响因子：
6.5
通讯作者：
Keegan THM
中科院分区：
文献类型：
--
作者：
Tao L;Clarke CA;Rosenberg AS;Advani RH;Jonas BA;Flowers CR;Keegan THM
随着利妥昔单抗的加入和其他治疗进展，弥漫性大b细胞淋巴瘤（DLBCL）后的生存得到改善，但随后的原发性恶性肿瘤（SPMs）已成为DLBCL生存的重要挑战。我们计算了1989-2012年间23,879例首次原发性DLBCL确诊后存活至少1年的SPMs患者与加州普通人群的标准化发病率（SIRs）和95%置信区间（CIs）。考虑到竞争死亡风险，SPMs的累积发病率（CMI）也被计算。我们发现急性髓性白血病（AML）的发病率在后利妥昔单抗时代几乎翻了一番[SIR (95%CI) 4.39（2.51-7.13）前（1989-2000）和8.70（6.62-11.22）后利妥昔单抗（2001-2012）]。随后的甲状腺癌在利妥昔单抗前是罕见的，但在2001年后显著增加[0.66 (0.08-2.37)vs. 2.27(1.44-3.41)]。所有SPMs（利妥昔单抗治疗前4.77% vs.利妥昔单抗治疗后5.41%，P=0.047）、AML （0.15% vs. 0.41%， P=0.003）、甲状腺癌（0.03% vs. 0.15%， P=0.003）和黑色素瘤（0.25% vs. 0.42%， P=0.020）的5年CMI在利妥昔单抗治疗后和利妥昔单抗治疗前诊断的DLBCL患者中更高。本研究为引入利妥昔单抗后SPM发生的变化模式提供了见解，这可能阐明SPM的病因，并应指导未来DLBCL患者的癌症监测工作。
With the addition of rituximab and other treatment advances, survival after diffuse large B-cell lymphoma (DLBCL) has improved, but subsequent primary malignancies (SPMs) have emerged as an important challenge for DLBCL survivorship. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for SPMs among 23,879 patients who survived at least 1 year after a first primary DLBCL diagnosed during 1989–2012, compared to the general population in California. Cumulative incidence (CMI) of SPMs, accounting for the competing risk of death, also was calculated. We found that the incidence of acute myeloid leukaemia (AML) nearly doubled in the post-rituximab era [SIR (95%CI) 4.39 (2.51–7.13) pre- (1989–2000) and 8.70 (6.62–11.22) post-rituximab (2001–2012)]. Subsequent thyroid cancer was rare pre-rituximab, but increased substantially after 2001 [0.66 (0.08–2.37) vs. 2.27(1.44–3.41)]. The 5-year CMI for all SPMs (4.77% pre- vs. 5.41% post-rituximab, P=0.047), AML (0.15% vs. 0.41%, P=0.003), thyroid cancer (0.03% vs. 0.15%, P=0.003) and melanoma (0.25% vs. 0.42%, P=0.020) were greater in DLBCL patients diagnosed in the post-versus pre-rituximab period. This study provides insight into the changing pattern of SPM occurrence after the introduction of rituximab, which may elucidate the aetiology of SPMs and should guide future cancer surveillance efforts among DLBCL patients.
影响因子：
5.8
作者：
Zhao J;Xu Z;Liu D;Lu Q
通讯作者：
Lu Q