title: Long-term complication in follicular lymphoma: assessing the risk of secondary neoplasm in 242 patients treated or not with 90-yttrium-ibritumomab-tiuxetan.
abstract: BACKGROUND
  Non-Hodgkin lymphoma patients have a 25% increased risk of secondary primary neoplasms (SPNs). Regarding the controversy about the increased risk of SPN in patients exposed to radioimmunotherapy (RIT), we have analyzed this issue in a cohort of follicular lymphoma (FL) patients treated with/without RIT.
  
  
  METHODS
  A retrospective study including all consecutive FL patients diagnosed since 2001 was performed. Demographic, clinical data including the incidence of any kind of neoplasm (excluding basocellular skin carcinoma) were recorded.
  
  
  RESULTS
  A total of 242 patients were registered, male/female: 103/139, mean age: 59.9 yr (15-86), stage IV (57.8%), and Follicular Lymphoma Prognostic Index (FLIPI) low-risk (62.15%) predominance. Ninety-six patients (39.7%) were treated with 90Y-IT. The median follow-up for patients treated or not with 90Y-IT was 61 (8-273) and 38 (1-171) months. With respect to SPN incidence, 38 (15.6%) patients have at least two cancers, in 17 (44.7%), FL was the SPN; for the rest (226), the global incidence of SPNs was 9.3% (21), but there were no differences related to the exposition or not to 90Y-IT (P = 0.26). In seven patients, more than two (2-6) different therapies were registered; four were exposed to fludarabine-based therapy, three to radiotherapy and two to autologous stem-cell transplantation, and in the RIT cohort, two patients developed myelodysplastic syndrome.
  
  
  CONCLUSIONS
  This is one of the largest single institution reports assessing the risk of SPN in FL patients treated (96) or not (146) with 90Y-IT. It seems that 90Y-IT does not increase significantly the risk of SPN but avoiding its use after fludarabine and other intense cytotoxic schemes is recommended.
authors.affiliation: Translational Research Unit, Aragon Health Research Institute (IIS-A), Zaragoza, Spain.|CIBER de Enfermedades Raras, CIBERER, Instituto Aragonés de Ciencias de la Salud (I+CS), Zaragoza, Spain.|Department of Hematology, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Marcio Miguel
authors.initials: MM
authors.lastname: Andrade-Campos
authors.affiliation: Department of Nuclear Medicine, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Paola
authors.initials: P
authors.lastname: Liévano
authors.affiliation: Department of Hematology, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Espinosa-Lara
authors.affiliation: Department of Hematology, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Soro-Alcubierre
authors.affiliation: Department of Hematology, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Grasa-Ulrich
authors.affiliation: Department of Hematology, Royo Villanova Hospital, Zaragoza, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: López-Gómez
authors.affiliation: Department of Nuclear Medicine, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Baringo
authors.affiliation: Translational Research Unit, Aragon Health Research Institute (IIS-A), Zaragoza, Spain.|CIBER de Enfermedades Raras, CIBERER, Instituto Aragonés de Ciencias de la Salud (I+CS), Zaragoza, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Giraldo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology*; D016499:Radioimmunotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; C422802:ibritumomab tiuxetan
keywords: follicular lymphoma; long-term follow-up; radioimmunotherapy; safety; secondary primary neoplasms