The impact of prior malignancies on the development of second malignancies and survival in follicular lymphoma: A population-based study

The association between radiotherapy and the prognosis of follicular lymphoma patients with different characteristics in the rituximab era: a cohort study based on Surveillance, Epidemiology and End Results

This retrospective cohort study examined the association between radiotherapy and prognosis in follicular lymphoma (FL) patients, with stratification by age, Ann Arbor stage, primary tumor site, surgical status, and grade. Using data from the SEER database, we employed Cox proportional hazards and competing risk models to assess the impact of radiotherapy on overall survival (OS) and cancer-specific survival (CSS) in 7,551 FL patients. The association between radiotherapy and second primary cancer (SPC) was explored using Logistic regression model. At the end of the 60-month follow-up, 6,053 patients were alive, while 1,498 had died. The overall result showed that radiotherapy was associated with the better OS [hazard ratio (HR): 0.70, 95% confidence interval (95%CI): 0.59-0.83, P < 0.001] and CSS (HR: 0.67, 95% CI: 0.52-0.87, P = 0.002)) in FL patients. Radiotherapy was associated with improved OS and CSS in patients aged ≥ 60 years [OS: HR: 0.65, CI: 0.53-0.79; CSS: HR: 0.63, CI: 0.52-0.77], early Ann Arbor stage (OS HR: 0.51, CI: 0.40-0.65; CSS HR: 0.51, CI: 0.40-0.65), primary sites at lymph nodes (OS HR: 0.76, CI: 0.62-0.93; CSS HR: 0.76, CI: 0.62-0.93) and skin/soft tissue (OS HR: 0.35, CI: 0.16-0.81; CSS HR: 0.36, CI: 0.16-0.82), and in both surgical (OS HR: 0.70, CI: 0.52-0.93; CSS HR: 0.70, CI: 0.52-0.93) and non-surgical patients (OS HR: 0.71, CI: 0.56-0.89; CSS HR: 0.69, CI: 0.55-0.87). Radiotherapy showed no significant association with second primary cancer (SPC) risk. These findings suggest radiotherapy improves 5-year survival outcomes in FL patients during the rituximab era.

Incidence and survival of second primary non-Hodgkin lymphoma: A Surveillance, Epidemiology, and End Results-based cohort study

BACKGROUND

The aim of this study was to investigate patient survival and factors associated with survival in second primary non-Hodgkin lymphoma (NHL) compared with the first primary NHL.

METHODS

The retrospective cohort study used data from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2014. Demographic characteristics, histological types, Ann Arbor stage, and treatment information were collected. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors associated with overall survival (OS) and cancer-specific survival (CSS) in the first and second primary NHLs.

RESULTS

Of 318,168 cases followed for 5 years, 299,248 patients developed the first primary NHL and 18,920 patients developed the second primary NHL. This study identified a rising incidence of first and second primary NHL from 2000 to 2014. For the second primary NHL, the OS risk was higher when compared to the first primary NHL (HR: 1.13, 95% CI: 1.11 to 1.15, P <0.001). Risk factors that negatively affected OS in the first primary NHL included being male, over 40 years of age, certain marital statuses, specific histological types, and advanced disease stages. In contrast, being of White race and having histological types such as Follicular Lymphoma (FL), Marginal Zone Lymphoma (MZL), and mantle B-cell NHL were associated with better OS outcomes. Treatments like surgery, radiation therapy, and chemotherapy were associated with a lower risk of OS and CSS in the first primary NHL. For the second primary NHL, the detrimental risk factors were similar but also included being over the age of 60. Certain histological types showed a lower OS risk relative to diffuse Large B-cell Lymphoma (DLBCL). While surgery and chemotherapy were beneficial for OS, radiation therapy did not improve survival in second primary NHL cases. Notably, undergoing chemotherapy for the first primary cancer increased the OS risk in the second primary NHL, whereas surgery and radiation seemed to offer a protective effect against OS risk in the second primary NHL (all P <0.05).

CONCLUSION

Our findings emphasize the need for tailored strategies in managing the second primary NHL, given the distinct survival patterns and risk factor profiles compared to the first primary NHL. Future research should aim to further elucidate these differences to improve prognosis and treatment approaches for second primary NHL patients.

Primary therapy and relative survival in patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia: a population-based study in the Netherlands, 1989-2018

It is unclear how treatment advances impacted the population‐level survival of patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia (LPL/WM). Therefore, we assessed trends in first‐line therapy and relative survival (RS) among patients with LPL/WM diagnosed in the Netherlands between 1989 and 2018 (N = 6232; median age, 70 years; 61% males) using data from the nationwide Netherlands Cancer Registry. Patients were grouped into three age groups (<65, 66–75 and >75 years) and four calendar periods. Overall, treatment with anti‐neoplastic agents within 1 year post‐diagnosis gradually decreased over time, following a broader application of an initial watch‐and‐wait approach. Approximately 40% of patients received anti‐neoplastic therapy during 2011–2018. Furthermore, use of chemotherapy alone decreased over time, following an increased application of chemoimmunotherapy. Detailed data among 1596 patients diagnosed during 2014–2018 revealed that dexamethasone‐rituximab‐cyclophosphamide was the most frequently applied regimen; its use increased from 14% to 39% between 2014 and 2018. The 5‐year RS increased significantly over time, particularly since the introduction of rituximab in the early–mid 2000s. The 5‐year RS during 1989–1995 was 75%, 65%, and 46% across the age groups compared to 93%, 85%, and 79% during 2011–2018. However, the survival improvement was less pronounced after 2011. Collectively, the impressive survival improvement may be accounted for by broader application of rituximab‐containing therapy. The lack of survival improvement in the post‐rituximab era warrants studies across multiple lines of therapy to further improve survival in LPL/WM.