Increased incidence of a second lymphoproliferative malignancy in patients with multiple myeloma--a SEER based study

BACKGROUND

Improving therapies means longer survival for multiple myeloma (MM) patients. We hypothesized that these patients are at an increased risk for a secondary malignancy.

OBJECTIVES

(i) To investigate the epidemiology and site-specific risk of second primary cancers (SPCs) in patients with MM (ii) To investigate the factors affecting survival in MM patients with SPCs.

DESIGN

This was a retrospective cohort study employing data available in the US Surveillance Epidemiology and End Results (SEER) database.

SUBJECTS

Adult patients (>18 years) where MM was the first of two, or more primary cancers, such that the diagnosis of MM and the SPC was separated by at least 1 month.

RESULTS

The age-adjusted rate SPCs in MM was 0.22 per 100,000 (95% CI=0.05-2.1). The incidence of SPCs was higher in patients aged ≥70 years, men and blacks. Age, gender and race were significant predictors for the occurrence of SPCs in MM. The risk of solid malignancies was significantly decreased (SIR: 0.94, 95% CI=0.89-0.99), while that of lymphohematopoieitc (LAHM) malignancies increased in MM (SIR: 1.68, 95% CI= 1.46-1.92). 5-year relative survival among MM patients with SPCs was higher in blacks (54.6%, 95% CI=49.5-59.4) than whites (53.8%, 95% CI=51.3-56.3) or other races (49.9%, 95% CI=39.8-59.3). Multivariate analysis revealed that race, site of SPC and year of diagnosis were independent predictors of survival among MM patients with SPCs.

CONCLUSION

MM patients are at a higher risk of a second LAHM.

Polymorphisms in the MLL breakpoint cluster region (BCR)

The MLL gene is involved in many chromosomal translocations leading to both acute myeloid and lymphoid leukemia. Some patients treated for primary malignancies with chemotherapeutic agents that inhibit DNA topoisomerase II (topo II) develop treatment-related leukemia (t-AML) caused by MLL gene rearrangement. Whether these patients are unusually susceptible to anti-topo II drugs, or whether this is a random adverse event is unknown. To discover genetic polymorphisms that may predispose patients to t-AML development, we sequenced the 8.3-kb MLL breakpoint cluster region (BCR) from 22 patients who had been treated with topo II inhibitors and who developed t-AML and from 37 patients who did not, and from eight infants and 20 normal individuals. Four polymorphic sites within Alu repetitive elements were identified; three affected the length of poly-A tracts and one altered the size of a trinucleotide repeat. The three poly-A tract polymorphisms occurred with equal frequency in leukemic patients and controls and hence are not predictors of risk. The trinucleotide GAA repeat has three alleles: (GAA)4, (GAA)5, and (GAA)6. The (GAA)6 allele is very rare. The adult t-AML patients are almost exclusively (GAA)4/5 heterozygotes (83%), whereas the normal population is only 55% (GAA)4/5 heterozygotic and is represented equally by (GAA)4 and (GAA)5 homozygotes (20% each). Only certain trends could be established because of the small sample size of these leukemic groups. Whereas adult t-AML patients are more likely to be (GAA)4/5 heterozygotes, this is not statistically significant, and this polymorphism within the MLL BCR has only a suggestive association with t-AML development.

Surgical pathology of colorectal cancer in Filipinos: implications for clinical practice

BACKGROUND

A number of studies published in the Philippine literature have demonstrated certain peculiar clinicopathologic characteristics of colorectal cancer among Filipinos. This study presents the latest data and analyzes their implications for clinical practice.

STUDY DESIGN

The pathology reports of all patients who underwent operation for colorectal cancer at the Philippine General Hospital over a period of 7 years were reviewed.

RESULTS

One thousand two hundred seventy-seven patients were included. The male to female ratio was almost 1:1. The majority of patients were in the sixth and seventh decades of life, with a mean age of 55.3 years. Patients 40 years of age and younger made up 17% of the total. The site of cancer in order of frequency was rectum (49.8%), left colon (27.9%), and right colon (21.4%). Cancers of the right colon were more common in women, and rectal cancers were more frequent in men. Seventy-six percent of the tumors were well to moderately differentiated adenocarcinomas, and 6.7% were poorly differentiated. Mucinous and signet ring carcinomas were found in 11% and 1% of cases, respectively. Forty-four percent of patients had localized disease at the time of operation, 54% had regional disease, and 2% had disseminated disease. Associated predisposing conditions noted were polyps (4.7%), schistosomiasis (3%), and tuberculosis (1.5%).

CONCLUSIONS

Colorectal cancer in Filipinos exhibits a number of unique clinicopathologic features, such as a higher proportion of early age of onset tumors, more advanced stage at presentation, an association with chronic granulomatous diseases, and relatively rare occurrence with polyps. This might suggest the possibility of a different pathway for tumor development of colorectal cancer in this population of patients. Also, current screening guidelines advocated for the Western population might not be appropriate for Filipinos.

Pattern of malignant lymphoma in the United Arab Emirates--a histopathologic and immunologic study in 208 native patients

The aim of this study was to analyze the distribution of the various pathologic types of lymphoma in a native Arab population of the United Arab Emirates (UAE). Two hundred and eight patients with malignant lymphoma diagnosed over a 12-year period (1988-1999) were retrospectively studied morphologically and immunohistochemically with a panel of monoclonal antibodies and classified according to the revised European-American classification of lymphoid neoplasms (REAL). Of the 208 patients in the study, 41% had Hodgkin's disease (HD) and 59% had non-Hodgkin's lymphoma (NHL). The distribution of HD showed a predominance of nodular sclerosis and mixed cellularity types. Among NHLs, the most frequent type was diffuse large B cell (59% of all NHLs) followed by the Burkitt's type (13%). The proportion of primary extranodal NHL was 29%. Immunologically, the percentages of NHL with B-cell and T-cell phenotypes were 83 and 11, respectively. When the International Working Formulation was used, 34% of NHLs were classified as high grade, 59% as intermediate grade and only 7% as low-grade lymphomas.

Trends in the incidence of primary intracranial tumors in Kumamoto, Japan

BACKGROUND

The introduction of modern neuro-imaging techniques, as well as various environmental factors, have been changing the incidence and the proportions of the types of clinically diagnosed intracranial tumors. The aim of this study was to determine recent trends in the occurrence of primary intracranial tumors in the residents of Kumamoto Prefecture, Japan.

METHODS

We surveyed 2129 patients who were diagnosed with primary intracranial tumors between 1989 and 1998, with histological diagnosis being obtained in 71% of the patients.

RESULTS

Of the 2129 patients, 710 (33.3%) had meningiomas, 390 (18.3%) had pituitary adenomas, 315 (14.8%) had malignant gliomas, and 208 (9.8%) had schwannomas. The overall age-adjusted incidence rates were 10.97/100,000/year (males, 9.70; females, 11.86). One hundred and nine patients (5.1%) were younger than 15 years, and 480 patients (22.5%) were older than 70 years. The most common tumors in children were astrocytomas (37.6%), followed by germ-cell tumors (16.5%) and craniopharyngiomas (11.9%), medulloblastomas (11.0%), and ependymomas (4.6%). Meanwhile, the most common tumors in elderly residents were meningioma (51.7%), followed by malignant glioma (13.7%), pituitary adenoma (11.4%), schwannoma (7.7%), malignant lymphoma (4.6%), and astrocytoma (2.7%). The proportion of asymptomatic tumors increased, from 24.6% in 1989-1994 to 33.0% in 1995-1998; 169 (62.8%) were meningiomas, followed by pituitary adenomas (14.1%).

Childhood cancer in the south Asian population of England (1990-1992)

Cancer incidence in 1990-92 among English south Asian (residents with ethnic origins in India, Pakistan or Bangladesh) and non-south Asian children is compared. Standardized incidence ratios show significant overall excesses in south Asians (131), largely due to higher rates in south Asian boys, and specific excesses for leukaemia (141), lymphoid leukaemia (141), lymphoma (172) and hepatic tumours (375). Aetiological investigation is required.

Lymphoma and lymphoid leukemia incidence in Florida children: ethnic and racial distribution

BACKGROUND

Incidence reports for pediatric lymphoma and lymphoid leukemia in Hispanic subpopulations in the United States are rare. The authors hypothesized that Florida's Hispanic children would have higher risks of lymphoma and lymphoid leukemia compared with non-Hispanic white children.

METHODS

All cases of lymphoid leukemia, Hodgkin, non-Hodgkin, and Burkitt lymphoma (SEER International Classification of Diseases for Oncology codes) in children (< 15 years) in the Florida Cancer Data System (FCDS) from 1985 to 1997 were studied. Cases were classified as: 1) white, 2) Hispanic, or 3) black, and stratified by age. Age-adjusted rates for the three race-ethnic groups were calculated. Rates for Hispanics and blacks were compared with whites as standardized rate ratios (SRR) with 95% confidence intervals.

RESULTS

Seven hundred thirty-one incident cases of pediatric lymphoma and 1231 cases of lymphoid leukemia were identified during the study period. For children with lymphoma, the SRR for Hispanics was 1.32 (95% CI, 1.20-1.44), and for blacks, the SRR was 0.68 (95% CI, 0.63-0.72. For lymphoid leukemia, the SRR for Hispanics was 1.29 (95% CI, 1.28-1.30), and for blacks, the SRR was 0.55 (95% CI, 0.54-0.56). Similar rates were found for the Hodgkin and non-Hodgkin subgroups.

CONCLUSIONS

Incidences of Hodgkin and non-Hodgkin lymphoma were significantly higher in Florida's Hispanic children, with 30% increased relative risks, compared with whites. Black children had significantly decreased incidences and risk. Results for lymphoid leukemia were similar. Incidence of lymphoma in Florida's Hispanic children (primarily Cuban and Central American origin) differed from similar reports from Texas and California, where Hispanics are primarily of Mexican origin.

Prevalence of HTLV-I-associated T-cell lymphoma

In order to assess the prevalence rate of HTLV-1-associated T-cell lymphomas and human retrovirus infection in general, approximately 21,000 individuals representing various patient populations, retroviral risk groups, and blood donors were examined for HTLV-I, HTLV-II, HIV-1, or HIV-2 infection using serologic and PCR assays. The prevalence rates among volunteer blood donors were 0.02% and 0% for HTLV and HIV, respectively. Significantly increased HTLV prevalence rates were observed among paid blood donors, African American health care clinic patients, Amerindians, recipients of HTLV-positive cellular blood products, intravenous drug users, sexual contacts and family members of HTLV-positive people, and patients with primary thrombocytosis and other-than-low-grade non-Hodgkin's lymphoma (NHL). Among some of these groups there were significant differences in the prevalence of HTLV-I versus HTLV-II. The eight HTLV-positive NHL patients all had mature, high-grade, CD4+ T-cell lymphomas with clonally integrated HTLV-I, for a prevalence of 4% among other-than-low-grade NHL patients. Seven of the eight died from their disease within 2 years despite treatment. Interestingly, two groups at risk for HTLV infection, namely needle stick victims and recipients of HTLV-infected and/or pooled plasma products, showed no evidence for infection. Significantly increased HIV-1 prevalence was observed among paid blood donors, African Americans, homosexuals, female prostitutes, hemophiliacs, and other-than-low-grade NHL patients. Only one patient was infected with HIV-2. Of the nine HIV-positive, other-than-low-grade NHL patients, seven HIV-1 positives had B-cell lymphomas, one HIV-1 positive had an HTLV-I-positive CD4+ T-cell lymphoma, and one infected with HIV-2 had a CD4+ T-cell lymphoma that was HTLV negative. The data indicate that HTLV-I lymphoma, while uncommon, is not necessarily rare among other-than-low-grade NHL cases in the United States and, given its poor prognosis, should probably be studied separately in clinical trials.

[Epidemiology and geo-pathology of malignant lymphomas with special emphasis on Japanese lymphomas]

The descriptive epidemiology and geo-pathology of malignant lymphomas have been hampered by the absence of a unified classification. Recent proposal of the REAL classification which will soon become the WHO classification is a significant step toward better understandings of the epidemiology of this interesting neoplasia. Worldwide epidemic of non-Hodgkin's lymphoma was discussed with possible relationships to herbicides. General characteristics of Japanese lymphomas as compared to Western lymphomas were described with special emphasis on the correlation between the low incidence rates of follicular lymphomas and Hodgkin's lymphomas.

Extranodal head and neck lymphomas in Guatemala: high frequency of Epstein-Barr virus-associated sinonasal lymphomas

Sinonasal lymphomas of T cell or natural killer cell (T/NK cell) phenotype represent a subset of extranodal head and neck lymphomas. T/NK cell sinonasal lymphomas have been described in diverse geographic settings, including China, Japan, Peru, Northern Europe, and North America. The frequency of these lymphomas is highly dependent on the geographic location in which they occur, their incidence being low in Europe and North America and relatively high in Asian countries and in Peru. Regardless of their geographic location, they are typically associated with the Epstein-Barr virus (EBV). Few studies have addressed the relative frequency of sinonasal lymphoma within the group of extranodal head and neck lymphomas. We investigated the anatomic distribution, immunophenotypical profile, and EBV status of 33 cases of extranodal head and neck lymphoma from patients in Guatemala. The anatomic distribution of these lymphomas is similar to that seen in Asian countries: 17 (52%) in the sinonasal area, five (15%) in the palate, and 11 (33%) in other locations. Fifteen (88%) of the 17 sinonasal lymphomas showed a T or null cell phenotype with a strong association with EBV by in situ hybridization. Most Guatemalan patients with these lymphomas were of Mayan descent. In Guatemala, the relative frequency of sinonasal lymphomas within the group of head and neck lymphomas is significantly higher than that reported for Western countries. In addition, the relative frequency of T/NK versus B cell sinonasal lymphomas is higher than that described in North America and similar to that observed in Asian countries and Peru.

Socioeconomic factors in the families of children with lymphoid malignancy in the UAE

Children of subcontinental (Indian and Pakistani) origin living in the United Arab Emirates (UAE) have previously been shown to have a higher relative frequency of ALL when compared to other ethnic groups. To analyze the possible effect of social class in this difference, a study of socioeconomic factors was conducted through personal interviews with the families of 115 children with lymphoid malignancies. The patients belonged to three ethnic groups: (1) UAE; (2) other Arabs; and (3) Indian subcontinent. UAE parents had the highest income and number of rooms in their house, but the lowest level of education. Occupational categories were significantly different for the three ethnic groups. While 41% of the UAE fathers worked in the army or the police, the majority of Arab and subcontinental fathers worked as government administrators or professionals. UAE families had the highest number of children in the family, subcontinental families the lowest. The number of children per family was inversely related to the parents' education level. Multiple regression analysis showed parental education level and house size to be significantly associated with ethnicity, while parental consanguinity was significantly associated with the diagnosis of lymphoma. It is difficult to define social class in the UAE population. While income and property ownership would place the UAE nationals in the highest category and the subcontinental group in the lowest, education level and occupational category would place the Arab and subcontinental groups higher. The smaller family size and higher education level in subcontinental families corresponds to the previously found higher relative frequency of ALL in this ethnic group and could lend support to the possible infectious etiology of the disease.

Risk of cancer in migrants and their descendants in Israel: I. Leukaemias and lymphomas

Cancer registrations among young individuals (under age 30 years) for the 30-year period 1960-1989 were used to investigate the risk of leukaemia and lymphoma in migrants to Israel, and in their offspring, relative to Israel-born individuals with Israel-born parents. Relative risks by the father's continent of origin, and odds ratios by continent of origin of mother or both parents, adjusted for age, sex and period, were estimated. The leukaemias showed little variation in risk by birthplace, and no change between generations. For non-Hodgkin lymphoma, however, there were quite large differences in incidence, with relatively high rates in migrants from Asia and Africa. These persisted to some degree into the second generation, suggesting that inherited susceptibility may underlie some of the variation.

High risk of lymphomas in children of Asian origin: ethnicity or confounding by socioeconomic status?

To examine the role of ethnic origin as a risk factor for paediatric lymphoma, a cancer registry-based analysis was undertaken in Yorkshire, UK. Children of Asian ethnic origin were found to have an odds ratio for lymphomas of 1.60 (CI 0.98-2.62), after adjusting for age and sex. After adjusting also for 'super profile group' as an indicator of socioeconomic status, the estimate became 1.99 (CI 1.08-3.68). Hodgkin's disease and non-Hodgkin's lymphomas were analysed separately with similar results. Super profile group is an area-based measure and may not reflect the individual variation in living standards, especially among the Asian immigrants. Our results indicate that socioeconomic status does not confound the relationship between lymphomas and ethnic origin. However, there is a need for studies of ethnicity that include indicators of individual living standards or socioeconomic status.

Malignant neoplasms of the lymphatic and haematopoietic system in Circumpolar Inuit

Malignancies of the lymphatic and haematopoietic system in Circumpolar Inuit were studied as part of an international collaboration combining results from cancer registries for Alaska, Canada and Greenland. Low risk was observed for all such malignancies, including non-Hodgkin lymphoma, Hodgkin's disease, multiple myeloma and the combined leukaemias. Standardized incidence ratios (SIRs) of non-Hodgkin lymphoma ranged from 0.3 to 0.5 based on comparison populations in Connecticut (USA), Canada and Denmark. SIR of Hodgkins's disease ranged from 0.1 to 0.2. Acute leukaemias accounted for 78% of all microscopically verified leukaemias and chronic leukaemias for 6%. No clear time trends were observed except for increasing rates of the combined leukaemias among women from the first to the second half of the study period. The epidemiology of haematologic and lymphoproliferative malignancies in Inuit is comparable to results from Chinese and Japanese populations in Asia and may reflect protective environmental or genetic factors for these malignancies.

Ethnic differences in the lymphoid malignancies of children in the United Arab Emirates. A clue to aetiology?

Tawam Hospital is the major paediatric oncology referral centre in the UAE. During the past 11 years, 352 patients (0-12 years of age) were diagnosed to have a childhood malignancy. Leukaemia and lymphoma accounted for 62.7% of all tumours. Stage distribution for Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) showed a relatively high proportion of advanced stage disease. Histological analysis demonstrated a preponderance of lymphocyte predominance and mixed cellularity cases in Hodgkin's disease, and 2/3 of the NHL patients had small, non-cleaved cell lymphoma. Children fell into three main ethnic groups based on the origin/nationality of their parents: Group 1: UAE nationals and Omanis; Group 2: other Arabs; Group 3: Indian/Pakistani (subcontinental) origin. When compared for the relative proportion of leukaemia/lymphoma/other tumours, children of subcontinental origin had significantly more acute lymphoblastic leukaemia (ALL) and less lymphoma than the other two ethnic groups. This is probably due to the higher level of education and smaller family size in group 3 and lends support to the proposed infectious aetiology in ALL.

Is the risk of cancer increased in Asians living in the UK?

The pattern of cancer in white and Asian (Indian, Pakistani, and Bangladeshi) children living in the West Midlands Health Authority Region was investigated using age standardised incidence rates. Two sets of rates were calculated, a 10 year rate (1982-91) using survey based estimates of the ethnic population and a four year rate (1989-92) using the ethnic population counts from the 1991 census. The 10 year rates showed a significantly higher annual incidence of cancer in Asian (159.1/million/year) than in white (130.8) children. The pattern of cancers in Asian children was different, with an excess of lymphomas and germ cell tumours, and a deficit of rhabdomyosarcomas. These findings were confirmed by the four year rates. Although underestimation of the Asian population probably contributes to the apparent excess, there remains cause for concern that UK Asian children may be at higher risk of cancer. Accurate ethnic population figures and confirmatory studies are urgently required.

Epstein-Barr virus-associated gastric lymphoma in Hong Kong Chinese

We report 11 cases of gastric lymphoma that harbor the Epstein-Barr virus (EBV) encoded small messenger RNA, EBER-1, detected by in situ hybridization. The cases represented 18% of 61 consecutive gastric lymphomas from three institutions in Hong Kong between 1988 and 1993. The mean age of patients was 62 years (range, 33 to 87). The male to female ratio was 5:6. Nine of the 11 (81.8%) EBER-1+ gastric lymphomas were diffuse large cell lymphomas of B-cell type without low grade components. Macroscopically these lymphomas appeared either as large noncleaved cell (centroblastic) or immunoblastic type. From the available follow-up data, five of the nine patients with B-cell lymphoma were alive and well 48, 40, 14, 13, and 12 months, respectively, after gastrectomy and chemotherapy. One patient died of postoperative pneumonia and one died of a second malignancy (esophageal squamous carcinoma) 40 months after gastrectomy. None of the EBER-1+ B-cell gastric lymphomas showed histological features characteristic of low grade lymphoma of the mucosa-associated lymphoid tissue (MALT) type reported to be common in some Western countries. Of the two patients with T-cell lymphoma, one had a pleomorphic T-cell lymphoma and the other had an angiocentric lymphoma. The former was lost to follow-up after the biopsy and the latter presented with gastric perforation and died 1.5 months after gastrectomy. It is concluded that a significant proportion of gastric lymphomas in Hong Kong Chinese are EBV-related and that they show histological features more akin to conventional node-based lymphomas than to MALT-type lymphomas.

[Malignant solid tumors in the first year of life]

The records of all children in Northern Israel under the age of 1 year in whom a malignant solid tumor was diagnosed were analyzed. Between 1973-1990 such tumors were found in 39 boys and 25 girls. The overall annual incidence was 137.1 per million, and the incidence was higher in boys (1.9/1.0), in Jews compared to non-Jews (1.3/1.0), and in Ashkenazic Jews compared to Sephardic Jews (1.2/1.0). Neuroblastoma was the most common (52% of all malignancies), followed by Wilms' tumor (13%), CNS neoplasm (11%), retinoblastoma (8%), soft tissue sarcoma (6%), lymphoma (5%) and all others (6%). The retinoblastomas were all in non-Jews, but Jews had a higher incidence of neuroblastomas. No differences in incidence were observed in other neoplasms.