The clinical course of lung carcinoma in patients with chronic lymphocyticleukemia

BACKGROUND. Although patients with chronic lymphocytic leukemia (CLL) have an increased risk of developing second primary malignancies, including lung carcinoma, there is virtually no information about their clinical outcomes . To evaluate this, the authors reviewed their 20-year institutional experi ence with CLL patients who also had lung carcinoma. METHODS. The records of patients with diagnoses of both CLL and lung carcin oma seen between January 1977 and July 1998 were reviewed. The data collect ed included patient demographics, the tumor histology and stage, the type o f treatment for both CLL and lung carcinoma, the presence of a third malign ancy, the disease status at last follow-up, and the first site of relapse. Survival was calculated by the Kaplan-Meier method. RESULTS. From January 1977 to July 1998, 1329 patients with CLL were seen a t Memorial Sloan-Kettering Cancer Center. Twenty-six (1.9%) also had lung c arcinoma (19 males and 7 females). The median age of patients at the time C LL was diagnosed was 61 years, and for patients with lung carcinoma it was 68 years. Twenty-two patients (85%) were current or former smokers. Histolo gically, the lung carcinomas included 6 squamous cell carcinomas, 19 nonsqu amous carcinomas, and 1 small cell carcinoma. Ten patients (38%) had a thir d malignancy; these malignancies included melanoma, basal cell carcinoma, l aryngeal carcinoma, and colon carcinoma. Thirteen patients underwent surgic al resection and 13 were treated nonsurgically for lung carcinoma. A poor p erformance status precluded surgery for 3 patients with Stage I tumors and limited chemotherapy for all patients with advanced disease. The median sur vival following the diagnosis of lung carcinoma for patients treated surgic ally was 25 months, and for those treated nonsurgically it was 6 months. CONCLUSIONS, Approximately 2% of patients with CLL develop lung carcinoma. In this study, 85% of the patients were smokers. These patients had a high risk of a third primary malignancy. Lung carcinoma was diagnosed a decade a fter CLL. Patients who develop both diseases die of lung carcinoma and nor CLL or other solid tumors. CLL and poor performance status limit treatment, particularly for patients with unresectable lung carcinoma. (C) 1999 Ameri can Cancer Society.