27.5% of CLL Patients Are Diagnosed with Other Cancer at Some Point

[Guest guest]

[2790] Other Malignancies in Chronic Lymphocytic Leukemia/Small

Lymphocytic Lymphoma (CLL/SLL): Analysis of 2083 Patients. Session

Type: Poster Session, Board #19-III

Apostolia- Tsimberidou, O'Brien, McLaughlin, Sijin

Wen, Wierda, Hagop M. Kantarjian, Manning, Lerner,

Mark Hess, Emil J. Freireich, J. Keating Leukemia, University

of Texas M. D. Cancer Center, Houston, TX, USA; Lymphoma;

Biostatistics; Hematopathology

Introduction: Other malignancies are reported to occur with increased

frequency in patients with CLL/SLL because of disease- or therapy-

related immunosuppression. The purpose of this study was to assess

the frequency of other cancers in CLL/SLL patients and to compare

presenting characteristics and clinical outcomes between CLL/SLL

patients with and without other malignancies.

Patients and methods: We reviewed the records of patients diagnosed

with CLL/SLL at The University of Texas M. D. Cancer Center

from 1985 to 2005.

Results: Among 2189 consecutive patients with CLL/SLL, 2083 were

evaluable and 572 (27.5%) had another cancer: 39.5% of patients were

diagnosed with another cancer before CLL/SLL, 52% after CLL/SLL, 5%

prior to and after CLL/SLL, and 3.5% simultaneously with CLL/SLL.

Overall, 642 cancers were reported, including skin (30%), prostate

(13%), and breast cancers (9%), melanoma (8%), lymphoma (8%),

gastrointestinal (7%), lung (7%), urinary tract (5%), genital (4%)

and myeloid tumors (2%), head and neck (2%), endocrine (2%), and

brain cancer (1%), sarcoma (1%), and other cancers (1%).

The median number of other cancers was 1 (range, 1-4). The median

time to other cancers after CLL diagnosis was 3.4 years (range, 0-33

yrs). Other cancers were more common in patients with older age

(p<0.0001), higher serum 2-microglobulin (p<0.0001) or creatinine

levels (p=0.002), male gender (p=0.02), smoking history (p=0.02),

lower albumin (p=0.02) or hemoglobin levels (p=0.04), 17p, 6q, or 11q

deletion (p=0.03), and longer follow-up (p<0.0001).

The median follow-up was 6.2 yrs. Overall survival was shorter in

CLL/SLL patients with other cancers compared with those without

cancer (median, 10.1 yrs vs. 15.5 yrs; p<0.0001).

In treated patients with CLL, patients with other cancers had lower

rates of response (59% vs. 65%, respectively; p =0.049), failure-free

survival (median, 2.7 yrs vs. 3.5 yrs, respectively; p=0.002), and

survival (median, 9.8 yrs vs. 13.1 yrs, respectively; p < 0.0001)

compared with those without other cancers. Other malignancies were

noted in 303 (28.3%) of 1069 patients who required therapy for

CLL/SLL (median follow-up, 7.7 yrs [range, 0.1-33 yrs]) and in 268

(26.4%) of 1014 patients who did not require therapy (median follow-

up, 4.7 yrs [range, 0-31 yrs]) (p= 0.35).

The ratio of secondary malignancies/treated patients by therapy was

as follows: fludarabine (F)+/-prednisone, 44/173 (25%; median follow-

up, 15.9 yrs); F+cyclophosphamide ©, 23/119 (19%; median follow-up,

10.8 yrs); F+mitoxantrone (M), 9/53 (17%; median follow-up, 12.5

yrs); FC+rituximab ®/FCMR/FMR+dexamethasone (D), 54/492 (11%;

median follow-up, 5.9 yrs); R+/-GM-CSF, 6/132 (5%; median follow-up,

1.5 yrs), other therapies, 18/100 (18%; median follow-up, 8.3 yrs).

Conclusions: Other cancers were noted in 27.5% of patients with

CLL/SLL. Treated patients had similar rates of other cancers compared

to untreated patients (p= 0.35). Other malignancies increased

proportionally with time of follow-up and they were associated with

inferior outcomes in patients who required therapy for CLL/SLL.