title: Second cancer incidence in primary mediastinal B-cell lymphoma treated with methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin regimen with or without rituximab and mediastinal radiotherapy: Results from a monoinstitutional cohort analysis of long-term survivors.
abstract: Our aim is to assess the incidence of second cancer in long-time surviving primary mediastinal B-cell lymphoma (PMBCL) patients treated with combined radiochemoimmunotherapy (standard methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin with rituximab and mediastinal radiation therapy at a dose of 30 to 36 Gy). For this purpose, 92 points were evaluated. After a median overall survival of 137 months (range 76-212), we recorded second cancer in 3 of 80 long-surviving patients (3.75%) with cumulative incidence of 3.47% at 15 years and 11% at 17 years, with a 17-year second cancer-free survival of 82%. We observed 2 papillary thyroid cancers with a standardized incidence ratio (SIR) of 7.97 and an absolute excess risk (AER) of 17. 84 and 1 acute myeloid leukemia (AML) with an SIR of 66.53 and an AER of 10.05. No breast cancer occurred. Although we should take into account the limits of the proposed statistical analysis, combined modality treatment was related to a significant SIR and AER for thyroid cancer and acute myeloid leukemia.
authors.affiliation: Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Department of Statistical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alfò
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Di Rocco
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Ansuinelli
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.affiliation: Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Mattia F
authors.initials: MF
authors.lastname: Osti
authors.affiliation: Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.affiliation: Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.|IRCCS Neuromed, Pozzilli (IS), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.affiliation: Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Grapulin
authors.affiliation: Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Musio
authors.affiliation: Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bracci
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spagnoli
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Moleti
authors.affiliation: Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D000073116:Cancer Survivors; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000009:adverse effects / Q000627:therapeutic use; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012306:Risk; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate
keywords: lymphoma; myeloid leukemias; radiotherapy