Second Tumors

Patients with CLL have an increased incidence of nonhematologic neoplasms, particularly lung cancer.177-179 In a review by Lee et al.,180 25 percent of patients with CLL had second primary tumors, mostly skin cancers, and 7 percent of patients died of complications from these other malignancies rather than from CLL. Results of a randomized trial suggest that long-term treatment with chlorambucil may increase the susceptibility of patients to epithelial tumors.76 Recently, long-term data for over 200 patients treated on National Cancer Institute Group C protocols with nucleoside analogues were examined, and the number of observed and expected second tumors was compared.181 Patients included those with CLL treated with fludarabine and patients with hairy cell leukemia treated with 2-deoxycoformycin or 2-CdA. The most common second cancer found in patients with CLL was lung cancer. As compared with age-adjusted 1994 Surveillance and Epidemiology End Results rates for the general population, the observed/expected frequency for patients treated with fludarabine was 1.65 (95 percent confidence interval, 1.04 to 2.47). This increased rate, however, was consistent with the risk associated with the disease alone, and the authors concluded that despite their immunosuppressive properties, nucleoside analogues were not associated with an increased risk of second malignancies.

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