Survival outcomes of secondary cancers in patients with waldenström macroglobulinemia: An analysis of the SEER database

Abstract

We hypothesized that survival outcomes of WM patients who develop SM is distinct from the general population of individuals who develop those same malignancies. Using the SEER-18 data (2000-2011), we identified patients with cancers of the breast, prostate, lung, colorectum, bladder, melanoma, non-Hodgkin lymphoma (NHL), and acute leukemia, and compared their outcomes according to having antecedent WM or not. The outcome of interest was overall survival (OS), which was analyzed in proportional-hazard models adjusted for age, sex, race, and stage. We found that patients with WM who developed SM were older than population controls with those same cancers. In the multivariate analysis, WM cases with colorectal cancer (HR 1.97; P < 0.001), melanoma (HR 2.63; P < 0.001) and NHL (HR 5 1.35; P 5 0.02) had worse OS than controls with those respective cancers. WM patients with diffuse large B-cell lymphoma also had worse OS (HR 5 1.86; P 5 0.008). The utilization of surgery and radiation was similar between WM cases and controls, except lower rates of prostatectomy and melanoma surgery among WM patients. The survival of WM patients with colorectal cancer, melanoma, and NHL is worse than among general population controls, arguing in favor of age-appropriate cancer screening.

Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study

“…Additional clinical issues specific to CLL (a large percentage of patients observed without treatment, the frequent use of immunosuppressive purine analogues) may contribute to differences between patients with CLL and those with myeloma. We recently described outcomes of SPMs in patients with Waldenstrom macroglobulinemia, demonstrating worse OS but similar or better CSS compared with the general population, with the exception of poor outcomes in patients with colorectal cancer, a finding that is consistent with those of the current study . The results of the current study demonstrate that the risk of death from myeloma quantitatively dominates in the prognosis of patients with myeloma who develop common solid tumors.…”

“…Immune dysregulation related to hematologic Cancer February 15, 2019 cancer or immunosuppressive therapy also may affect the clinical course of a subsequent solid tumor. 11 However, to the best of our knowledge, outcomes of SPMs diagnosed among patients with myeloma have not been described to date.…”

“…Because of the ongoing risk of myeloma progression and exposure to high‐dose therapy and autologous stem cell transplantation, as well as long‐term maintenance therapy with immunomodulatory drugs, patients who experience SPMs may be at a disadvantage with regard to treatment options or subsequent outcomes of the second cancer. Studies of SPMs occurring among patients with other hematologic malignancies such as chronic lymphocytic leukemia (CLL) or Waldenstrom macroglobulinemia have demonstrated shortened OS compared with the general population diagnosed with the same cancers . These disparities have been postulated to result from an older age at the time of diagnosis, as well as potentially less intense treatments of SPMs among survivors.…”

“…These disparities have been postulated to result from an older age at the time of diagnosis, as well as potentially less intense treatments of SPMs among survivors. Immune dysregulation related to hematologic cancer or immunosuppressive therapy also may affect the clinical course of a subsequent solid tumor . However, to the best of our knowledge, outcomes of SPMs diagnosed among patients with myeloma have not been described to date.…”

“…Studies of SPMs occurring among patients with other hematologic malignancies such as chronic lymphocytic leukemia (CLL) or Waldenstrom macroglobulinemia have demonstrated shortened OS compared with the general population diagnosed with the same cancers. [11][12][13] These disparities have been postulated to result from an older age at the time of diagnosis, as well as potentially less intense treatments of SPMs among survivors. Immune dysregulation related to hematologic Cancer February 15, 2019 cancer or immunosuppressive therapy also may affect the clinical course of a subsequent solid tumor.…”