2ND CANCERS AMONG LONG-TERM SURVIVORS OF NON-HODGKINS-LYMPHOMA

Background: Patients with non-Hodgkin's lymphoma (NHL) are at increase d risk for second cancers. Few studies, however, include long-term sur vivors, and none report risk for second cancer among NHL patients surv iving 15 or more years. Purpose: Our aim was to examine the pattern of second cancers among long-term survivors of NHL. Methods: A cohort of 6171 patients diagnosed with NHL as a first primary cancer and who su rvived 2 or more years was identified within population-based tumor re gistries in Sweden, Ontario, and Iowa and within the affiliated tumor registry of The Netherlands Cancer Institute. Nearly 1000 NHL patients lived 15 or more years after diagnosis. Tumor registry files were sea rched for new invasive primary malignancies. Results: Second cancers w ere reported in 541 subjects (observed-to-expected ratio [O/E] = 1.37; 95% confidence interval = 1.26-1.49), with significant excesses seen for all solid tumors (O/E = 1.28), acute nonlymphocytic leukemia (O/E = 4.83), melanoma (O/E = 2.38), Hodgkin's disease (O/E = 12.0), and ca ncers of the lung (O/E = 1.36), brain (O/E = 2.33), kidney (O/E = 2.07 ), and bladder (O/E = 1.77). Among 15-year survivors, significantly in creased risks persisted for all second cancers (O/E = 1.45), solid tum ors (O/E = 1.37), bladder cancer (O/E = 3.24), and Hodgkin's disease ( O/E = 25.0). The actuarial risk of developing a second cancer 3-20 yea rs after diagnosis of NHL was 21%, compared with a population expected cumulative risk of 15%. Conclusions: Patients with NHL continue to be at significantly elevated risk of second primary cancer for up to two decades following diagnosis. The pattern of risk suggests the influen ce of treatment as well as factors associated with the underlying dise ase. Implications: Quantitative studies of second cancer following NHL are needed to clarify the role of antecedent therapy, shared risk fac tors, host susceptibility, and other etiologic and diagnostic influenc es. Despite the generally advanced age of patients with NHL, the persi stently elevated risk of second cancers should alert clinicians to the importance of continued medical surveillance.