Researchers from Wayne State University have reported that patients with Hodgkins lymphoma (HL), non-Hodgkins lymphoma (NHL), and chronic lymphocytic leukemia (CLL) have a 30-300% increased risk of developing lung cancer compared with controls without these diseases. The details of this study were reported at the 2008 meeting of the American Society of Clinical Oncology in Chicago, May 30-June 2.¹ 

Patients with one malignancy are at increased risk of developing a second malignancy. However, the magnitude of the risk varies from cancer to cancer and with different types of treatment. Very little has been written about the specific risk of lung cancers in patients with lymphoid malignancies.

The current study found that 2% of 83,423 patients with HL, NHL, or CLL developed lung cancer. For patients with HL, there was a 300% increase in the incidence of lung cancer, 30% in NHL, and 60% in CLL. The increased incidence of other second primary cancers was 93% for HL, 8% for NHL, and 6% for CLL. The increased risk of developing lung cancer was greatest in the patients <50 years of age with relative risks of 4.57 for HD, 2.25 for NHL, and 3.42 for CLL. Patients >age 70 at diagnosis were not at increased risk of developing lung cancer. The median time to develop lung cancer was nine years for patients with HD, six years for patients with NHL, and five years for patients with CLL. The histology of lung cancers was non–small cell in 92% of cases and small cell in 8%. However, 15% of HD patients had small–cell lung cancer.

Comments: The very high risk in HL may reflect the effects of radiation therapy, which is more frequent in HL than NHL, but these data were not presented. The major message of this presentation is that younger patients with lymphoma/CLL are at high risk of developing lung cancer and should be enrolled in screening programs.

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Reference:

¹ Arunselvan SK, Schwartz A, Schiffer C, et al. Risk of lung cancer in Hodgkins (HL), non-Hodgkins (NHL and chronic lymphocytic leukemia (CLL) patients (pts): Analysis of the Surveillance Epidemiology and End Results (SEER) data. Journal of Clinical Oncology. 2008;26:abstract 8611.