Second Malignancies Following Systemic Treatment of Hairy Cell Leukemia

One study has now documented an unexpected high incidence of second neoplasms in patients after treatment of HCL with alpha-2b interferon.110 Of 69 patients followed for a median of 91 months, 13 patients (19 percent) developed a second neoplasm, of which 6 were of hematopoietic origin and 7 were ade-nocarcinomas. The median survival after diagnosis of the second neoplasm was only 8.8 months.

Saven et al. reported on 358 HCL patients treated with 2-CdA of whom 27 (23 males) developed second malignancies.90 The majority of these second neoplasms were melanoma and adenocarcinomas of the prostate, colon, and stomach. The observed-to-expected ratio of second cancers was 1.88 (95 percent, confidence interval 1.24 to 2.74). Kurzrock et al. reported that 26 of 350 HCL patients developed second malignancies.111 There was no excess cancer risk observed in HCL patients treated with purine nucleoside analogues, but a higher incidence of lymphoma and myeloma was noted. Other investigators did not demonstrate an increased incidence of second malignancies in HCL patients similarly treated.112

Finally, Au et al. reported on the relative risk of second malignancies in 117 HCL patients compared with an age-matched cohort; 36 percent of patients developed a second cancer and 5 percent had two or more malignancies.113 Also, 10 percent of patients had been diagnosed with cancer before the diagnosis of HCL was established. The increased relative risk of malignancy in the HCL group slowly decreased to baseline over time, which suggests that hairy cell burden, rather than treatment, contributed to this occurrence.

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