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Identification of Risk Factors for Melanoma in Survivors of Non-Hodgkin Lymphoma

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Key Points

  • T-cell–activating conditions and fludarabine use were associated with an increased risk among patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.
  • Among patients with other non-Hodgkin lymphoma subtypes, melanoma risk was not associated with specific treatments or T-cell immune conditions overall.

Risk for melanoma has been found to be increased in non-Hodgkin lymphoma (NHL) survivors. In a study reported in the Journal of Clinical Oncology, Lam et al found that T-cell–activating autoimmune diseases and fludarabine use were associated with an increased melanoma risk among patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) but not among those with other NHL subtypes.

In the study, second melanoma risk was evaluated among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 included in the Surveillance, Epidemiology, and End Results-Medicare database.

Risk in CLL/SLL

A total of 202 melanoma cases were identified, including 91 after CLL/SLL and 111 after other NHL subtypes, with a cumulative incidence by age 85 years of 1.37% and 0.78%. Risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with (n = 18; hazard ratio [HR] = 1.92, 95% confidence interval [CI] = 1.09–3.40) or without rituximab (Rituxan; n = 10; HR = 2.92, 95% CI = 1.42–6.01) and among patients with T-cell–activating autoimmune diseases diagnosed before CLL/SLL (n = 36; HR = 2.27, 95% CI = 1.34–3.84) or after CLL/SLL (n = 49; HR = 2.92, 95% CI = 1.66–5.12).

Among individual T-cell–activating conditions, hazard ratios were significantly increased for Graves’ disease (2.66) and psoriasis (2.68) diagnosed before CLL/SLL, chronic rheumatic heart disease (2.31) and skin-related autoimmune conditions (1.87) after CLL/SLL, and asthma both before and after CLL/SLL (2.14 and 3.24).

Risk in Other NHLs

Among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or T-cell immune conditions overall. However, among individual immune conditions, hazard ratios were significant for localized scleroderma before non-CLL/SLL diagnosis (1.88) and for nervous system autoimmune conditions (5.44) before non-CLL/SLL diagnosis.

Numerous infections were diagnosed among patients. Cellulitis diagnosed before CLL/SLL and cystitis/pyelonephritis urinary tract infections diagnosed before and after CLL/SLL were associated with an elevated melanoma risk. Among patients with other NHL subtypes, melanoma risk was increased by pneumonia and urinary tract infections diagnosed before NHL and by gastrohepatic infections and cystitis/pyelonephritis urinary tract infections diagnosed after NHL.

The investigators concluded: “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.”

Clara J. K. Lam, MD, of the National Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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