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Lam CJK, Curtis RE, Dores GM, Engels EA, Caporaso NE, Polliack A, Warren JL, Young HA, Levine PH, Elmi AF, Fraumeni JF, Tucker MA, Morton LM. Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma. J Clin Oncol 2015; 33:3096-104. [PMID: 26240221 DOI: 10.1200/jco.2014.60.2094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Previous studies have reported that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing cutaneous melanoma; however, risks associated with specific treatments and immune-related risk factors have not been quantified. PATIENTS AND METHODS We evaluated second melanoma risk among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 and included in the Surveillance, Epidemiology, and End Results-Medicare database. Information on NHL treatments, autoimmune diseases, and infections was derived from Medicare claims. RESULTS A total of 202 second melanoma cases occurred among survivors of NHL, including 91 after chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and 111 after other NHL subtypes (cumulative incidence by age 85 years: CLL/SLL, 1.37%; other NHL subtypes, 0.78%). Melanoma risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with or without rituximab (n=18: hazard ratio [HR], 1.92; 95% CI, 1.09 to 3.40; n=10: HR, 2.92; 95% CI, 1.42 to 6.01, respectively). Significantly elevated risks also were associated with T-cell activating autoimmune diseases diagnosed before CLL/SLL (n=36: HR, 2.27; 95% CI, 1.34 to 3.84) or after CLL/SLL (n=49: HR, 2.92; 95% CI, 1.66 to 5.12). In contrast, among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or with T-cell/B-cell immune conditions. Generally, infections were not associated with melanoma risk, except for urinary tract infections (CLL/SLL), localized scleroderma, pneumonia, and gastrohepatic infections (other NHLs). CONCLUSION Our findings suggest immune perturbation may contribute to the development of melanoma after CLL/SLL. Increased vigilance is warranted among survivors of NHL to maximize opportunities for early detection of melanoma.
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Affiliation(s)
- Clara J K Lam
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel.
| | - Rochelle E Curtis
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Graça M Dores
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Eric A Engels
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Neil E Caporaso
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Aaron Polliack
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joan L Warren
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Heather A Young
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Paul H Levine
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Angelo F Elmi
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joseph F Fraumeni
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Margaret A Tucker
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Lindsay M Morton
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
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