Abstract
Introduction: Follicular lymphoma (FL) is the most common indolent lymphoma. Most of the patients with FL respond to first-line treatment. Relapses are common, and many patients need to be re-treated. There has been major improvement in treatment of indolent non-Hodgkin lymphomas in last 10 years. This is the result of the use of therapeutic antibodies such as rituximab. With improved survival patients have potentially more time to develop secondary malignancies. Secondary malignancies are important causes of morbidity and mortality in patients with indolent lymphomas. Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are important subsets of secondary malignancies. Incidence of secondary hematological malignancies among different lymphomas is largely unknown. We collected data of patients with FL to find out the incidence of secondary hematological malignancies. We also wanted to know if the incidence is related to certain types of treatment or chemotherapy regimens. Methods: This is a retrospective registry study. Clinical data were collected from three hospitals in Finland and from one hospital in Spain. We analyzed clinical data from hospital records of all patients with FL diagnosed between 1997 and 2016. A total of 492 patients were included in this study. Information such as age, stage, details of treatment, possible relapses, current status and details about secondary hematological malignancy was investigated. Results: Median follow-up time was 6.2 years. Mean age at the time of diagnosis was 59 (17–88) and half (50.2%) were women. Altogether 86% of patients received treatment for lymphoma; 1-year PFS was 89.2% and 5-year PFS 58.3%; 5-year DSS was 90.5% and 5-year OS 81.9%. In patients treated with stem-cell transplantation (SCT), the risk of secondary hematological malignancy was 6.5% compared to only 0,8% (P = ns) in patients treated without SCT. In patients treated with fludarabine, the risk of secondary hematological malignancy was 5.6%, and correspondingly, the risk was 0,8% (P = ns) in patients treated without fludarabine. In patients treated with anthracyclines the risk of secondary hematological malignancy was 1.8% and in patients treated without anthracyclines the risk was 0% (P = ns). Conclusions: With current treatment, the prognosis of follicular lymphoma is relatively good. Risk of secondary hematological malignancy is low if anthracyclines, fludarabine or SCT isn't used in the treatment. Especially, SCT is associated with higher risk for secondary malignancies. When prognosis is getting better, it's important to pay attention to which patients are treated with SCT. Keywords: follicular lymphoma (FL).
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