Hodgkin lymphoma in a child with sickle cell anemia

Risk of individual malignant neoplasms in patients with sickle cell disease: English national record linkage study

OBJECTIVE

Case reports suggest that there may be an increased risk of some cancers associated with sickle cell disease. However, population-based studies are scarce and there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this.

DESIGN

We used an English national dataset of linked statistical records of hospital admissions and deaths from 1999 to 2011 to undertake a retrospective cohort study.

SETTING

England.

PARTICIPANTS

Records of all hospital admissions in England with SCD or with conditions included in the control cohort.

MAIN OUTCOME MEASURES

Rate ratios were calculated comparing rates of cancer in a sickle cell disease cohort and a control cohort, confining the analyses to people whose ethnicity was recorded as Black.

RESULTS

Comparing the sickle cell disease cohort with the cohort without sickle cell disease, the rate ratio for all cancers combined was 2.1 (95% confidence interval 1.7-2.5). There were significantly high rate ratios for haematological malignancies, including Hodgkin's lymphoma (rate ratio 3.7, 1.5-8.4), non-Hodgkin's lymphoma (2.6, 1.3-4.8), multiple myeloma (5.5, 2.8-10.1), lymphoid leukaemia (3.3, 1.3-8.0) and myeloid leukaemia (10.0, 4.6-21.5). Four solid tumours showed elevated rate ratios: colon cancer (2.8, 1.2-5.5), non-melanoma skin cancer (4.4, 1.3-12.2), kidney cancer (5.4, 2.3-11.5) and thyroid cancer (5.1, 1.3-15.4).

CONCLUSIONS

The risk of some malignancies may be raised in patients with sickle cell disease. However, this study was based on administrative data without the scope to validate these against patients' full clinical records. Our findings need confirmation or refutation. If confirmed, work to elucidate, at the genetic and molecular level, why people with sickle cell disease have elevated risks of individual cancers might make contributions to the fundamental understanding of carcinogenesis.

Adverse events in cancer patients with sickle cell trait or disease: case reports

PURPOSE

Given the relatively high prevalence of sickle cell trait and disease among African Americans and established racial disparities in cancer outcomes, we reviewed the literature regarding adverse events in cancer patients with these hematologic genotypes. Erythrocyte sickling can result from extreme hypoxia and other physiologic stressors, as might occur during cancer therapy. Further, tumoral hypoxia, a poor prognostic and predictive factor, could lead to a cycle of local sickling and increased hypoxia.

METHODS

A search of PubMed produced 150 publications, most of which were excluded because of incidental relevance. Eleven case reports of patients diagnosed from 1993 to 2013 were reviewed.

RESULTS

Two reports of patients with sickle cell trait describe an abundance of sickled erythrocytes within tumors, and a third report describes sickling-related events requiring multiday hospitalization. Eight reports of patients with sickle cell disease delineated multiorgan failure, vaso-occlusive crises, and rapid renal deterioration. Hypothesized triggers are delayed clearance of anticancer agents attributable to baseline kidney damage, activation of vasoadherent neutrophils from treatment to counter chemotherapy-induced neutropenia, hypoxia from general anesthesia, and intratumoral hypoxia.

CONCLUSION

Clinical implications include pretreatment genotyping for prophylaxis, dose adjustment, and enhanced patient monitoring. With the current lack of high-quality evidence, however, the scope of poor outcomes remains unknown.