Tailored, site- and time-specific surveillance of patients with diffuse large B-cell lymphoma (DLBCL) may be warranted in order to accurately address the development of secondary primary malignancies (SPMs), according to research published in Cancer.

Researchers used the Surveillance, Epidemiology, and End Results (SEER) database to identify 26,038 patients aged 18 years or older who had been diagnosed with primary DLBCL between 1973 and 2010. Patients were categorized into 2 groups: early stage (ES), defined as stage I or II disease (14,724 patients), and advanced stage (AS), defined as stage III or IV disease (11,314 patients). Differences in the overall number and location of SPMs in these patients were assessed and classified by stage and time since diagnosis.

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After a median follow-up of 13.3 years, 13.0% of patients developed an SPM. Patients with ES disease demonstrated an increased risk for SPM development compared with those with AS disease, though this difference was not statistically significant (14% vs 11.6%; P =.14).

In the first 5 years following diagnosis, patients with ES disease were found to have a higher risk for colorectal, pancreatic, breast, and prostate SPMs compared with patients who had AS disease. Conversely, at 10 to 15 years following diagnosis, patients with AS disease were found to have a higher risk for hematologic SPMs compared with patients who had ES disease.

The development of any SPM was associated with a significant increase in risk for death regardless of stage at diagnosis. Other risk factors for SPM development included white race, male gender, extranodal disease, and diagnosis in the postrituximab era (defined as starting in 2001).

The investigators noted that this study was the largest population-based study of SPM in patients with primary DLBCL thus far and that the 5-year intervals used to study disease progression may offer a more nuanced description of the risk for developing SPMs over time. They concluded that SPM development in this patient population is not uniform in all patients; thus, disease stage at diagnosis and time since diagnosis need to be considered in order to design tailored monitoring protocols. 

Reference

1.     Major A, Smith DE, Ghosh D, Rabinovitch R, Kamdar M. Risk and subtypes of secondary primary malignancies in diffuse large B‐cell lymphoma survivors change over time based on stage at diagnosis [published online September 11, 2019]. Cancer. doi:10.1002/cncr.32513