KEY TAKEAWAYS
- The study aimed to investigate the long-term consequences of radiotherapy, alkylating agents, and anthracycline-containing (immuno) chemotherapy in DLBCL survivors.
- Researchers noticed an elevated risk of SMNs in five-year DLBCL survivors, highlighting potential benefits in the rituximab era; further investigation is ongoing.
Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma with varying outcomes. The introduction of rituximab significantly improved prognosis, underscoring the need to assess the long-term consequences of DLBCL treatments.
Y M Geurts and the team aimed to evaluate the impact of radiotherapy, alkylating agents, and anthracycline-containing (immuno)chemotherapy on DLBCL survivors.
They performed an inclusive analysis examining the long-term risk of subsequent malignant neoplasms (SMNs) in a multicenter cohort comprising 2373 5-year DLBCL survivors treated at ages 15-61 years between 1989 and 2012.
Observed SMN numbers were compared with expected cancer incidence to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10 000 person-years). Treatment-specific risks were assessed using multivariable Cox regression.
About 321 survivors developed one or more SMNs after a median follow-up of 13.8 years (SIR 1.5, 95% CI 1.3-1.8, AER 51.8). SIRs remained elevated for at least 20 years post-first-line treatment (SIR ≥20-year follow-up 1.5, 95% CI 1.0-2.2, AER 81.8), with the highest rates observed among patients ≤40 years at first DLBCL treatment (SIR 2.7, 95% CI 2.0-3.5). Lung (SIR 2.0, 95% CI 1.5-2.7, AER 13.4) and gastrointestinal cancers (SIR 1.5, 95% CI 1.2-2.0, AER 11.8) accounted for the most significant excess risks.
Treatment with >4500 mg/m2 cyclophosphamide/>300 mg/m2 doxorubicin versus ≤2250 mg/m2/≤150 mg/m2, respectively, were associated with increased solid SMN risk (HR 1.5, 95% CI 1.0-2.2). Survivors who received rituximab had a lower risk of subdiaphragmatic solid SMNs (HR 0.5, 95% CI 0.3-1.0) compared with those who did not receive rituximab.
The study concluded that 5-year DLBCL survivors face an increased risk of SMNs, particularly those treated at a younger age and with higher doses of cyclophosphamide and doxorubicin. However, survivors treated in the rituximab era may have a potentially lower risk of SMNs.
These findings underscore the importance of conducting longer follow-up studies specifically focusing on rituximab-treated patients.
The study was sponsored by the Dutch Cancer Society
Source: https://pubmed.ncbi.nlm.nih.gov/38350338/
Geurts YM, Neppelenbroek SIM, Aleman BMP, et al. (2024). ‘’Treatment-specific risk of subsequent malignant neoplasms in five-year survivors of diffuse large B-cell lymphoma.’’ ESMO Open. 2024 Feb;9(2):102248. doi: 10.1016/j.esmoop.2024.102248. Epub 2024 Feb 12. PMID: 38350338.
