Increased risk of second primary hematologic and solid malignancies in patients with mycosis fungoides: A Surveillance, Epidemiology, and End Results analysis - 18/10/19

Doi : 10.1016/j.jaad.2019.07.075

Amrita Goyal, MD ^a,^⁎ , Daniel O'Leary, MD ^b,^e, Kavita Goyal, MD ^a, Nathan Rubin, MS ^c, Kimberly Bohjanen, MD ^a, Maria Hordinsky, MD ^a, Steven T. Chen, MD, MPH ^d, Georgios Pongas, MD ^e, Lyn M. Duncan, MD ^f, Aleksandr Lazaryan, MD, MPH, PhD ^g
^a Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
^b Department of Medicine, University of Minnesota, Minneapolis, Minnesota
^c Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
^d Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^e Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
^f Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
^g Department of Hematology-Oncology, Moffitt Cancer Center, Tampa, Florida

^∗Correspondence to: Amrita Goyal, MD, 516 Delaware St SE, Minneapolis, MN 55455.516 Delaware St SEMinneapolisMN55455

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Abstract

Background

Mycosis fungoides (MF) is associated with increased risk of second primary hematologic malignancies, but its association with second primary solid tumors is less well characterized.

Objective

This retrospective analysis seeks to assess the risk of being diagnosed with a second primary hematologic or solid malignancy in patients with MF.

Design

We performed an analysis of patients diagnosed with MF from 2000 through 2015 in the United States cancer registries of SEER-18 (N = 6742).

Results

Relative risks were estimated by using standardized incidence ratios (SIRs). Among 6742 patients, there were 511 (7.5%) second cancer events (SIR, 10.15; 95% confidence interval [CI], 9.29-11.07). These included 184 (36.0%) hematologic malignancies (SIR, 39.71; 95% CI, 34.05-46.05) and 327 (64.0%) solid tumor malignancies (SIR, 7.33; 95% CI, 6.56-8.17). Patients with MF were at increased risk for non-Hodgkin lymphoma; Hodgkin lymphoma; melanoma; and lung, female breast, prostate, colon, and renal cancers. Females were at higher risk than males (P < .05). All ethnic groups showed a statistically significant elevation in SIRs. Elevation of SIRs was observed across all stages of MF.

Conclusions and Relevance

Patients with MF are at increased risk for diagnosis of second primary malignancies and should be carefully screened for discernable signs and symptoms of second malignancies.

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Key words : CTCL, cutaneous lymphoma, cutaneous T-cell lymphoma, mycosis fungoides, non-Hodgkin lymphoma, second malignancy, SEER, Surveillance Epidemiology and End Results

Abbreviations used : CI, HR, MF, SEER, SIR

Plan

Materials and methods

Patients and design

Statistical analysis

Results

MF and incidence of second malignancy

Risk of second primary malignancy by sex and race

Risk of second primary malignancy by stage

Risk of second malignancy as a function of time since MF diagnosis

Risk of second malignancy as a function of age at the time of MF diagnosis

Survival analysis

Discussion

	Funding sources: Supported by an HONORS (Hematology Opportunities for the Next Generation of Research Scientists) award research grant from the American Society of Hematology. Statistical analysis was in part supported by National Institutes of Health grant P30 CA77598 usign the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health award number UL1TR000114. This funded the statistical analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
	Conflicts of interest: None disclosed.
	Reprints not available from the authors.