title: Risk factors for development of a second lymphoid malignancy in patients with chronic lymphocytic leukaemia.
abstract: Previous studies suggested that patients with chronic lymphocytic leukaemia (CLL) are at a three- to fivefold increased risk of developing a second lymphoproliferative disorder (LPD). This observational cohort study used the Mayo Clinic CLL Database to identify factors associated with developing a second LPD. A second LPD was identified in 26 (2.7%) of 962 CLL patients during a median follow-up of 3.3 years. Diffuse large B-cell lymphoma was the most common subtype of secondary LPD (12 of 26 cases). Patients previously treated for CLL had a trend toward higher prevalence of second LPD (4%) compared with previously untreated patients (2%; P = 0.053). More strikingly, patients treated with purine nucleoside analogues (PNA) had a significantly increased risk of subsequent second LPD (5.2%) compared with patients who had not received PNA (1.9%; P = 0.008). No statistically significant association was observed between risk of second LPD and other CLL characteristics (ZAP-70, CD38, IgV(H) mutation status or cytogenetic abnormalities). In this series, prior treatments with PNA or anthracyclines were the only significant factors associated with risk of developing a second LPD in patients with CLL. Physicians should strictly adhere to established criteria to initiate treatment for CLL patients who are not participating in clinical trials.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Kami
authors.initials: K
authors.lastname: Maddocks-Christianson
authors.forename: Susan L
authors.initials: SL
authors.lastname: Slager
authors.forename: Clive S
authors.initials: CS
authors.lastname: Zent
authors.forename: Megan
authors.initials: M
authors.lastname: Reinalda
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Call
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Bowen
authors.forename: James D
authors.initials: JD
authors.lastname: Hoyer
authors.forename: Susan
authors.initials: S
authors.lastname: Schwager
authors.forename: Diane F
authors.initials: DF
authors.lastname: Jelinek
authors.forename: Neil E
authors.initials: NE
authors.lastname: Kay
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008223:Lymphoma / Q000139:chemically induced / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000209:etiology*; D011379:Prognosis; D011685:Purine Nucleotides / Q000009:adverse effects; D012307:Risk Factors; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000970:Antineoplastic Agents; D011685:Purine Nucleotides; D014740:Vidarabine; C024352:fludarabine