Increased Risk of Second Malignancies in Hairy Cell Leukemia
Researchers from the National Cancer Institute have reported that patients with hairy cell leukemia have an increased risk of developing non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and thyroid cancer. The details of this study appeared in the February 7, 2007, issue of the Journal of the National Cancer Institute.
Hairy cell leukemia is a relatively rare, chronic B-cell lymphoproliferative disorder that responds to multiple therapies and is associated with a recent improvement in survival. Hairy cells are made up of activated B-cells that co-express CD11c, CD19, CD20, CD22, CD25, and CD103, and all express annexin A1. This is usually an indolent disease with neutropenia, anemia, thrombocytopenia, symptomatic splenomegaly, and constitutional symptoms. Patients are usually treated initially with Leustatin® (2-CdA, cladribine) which results in reported relapse-free survivals of 70-80% at 4-5 years. However, other treatments such as Nipent® (deoxycoformycin, pentostatin), interferon-alpha, splenectomy, and Rituxan® are also effective.
In the current study, the incidence of second malignancies among over 3,000 patients with hairy cell leukemia was determined. The average follow-up for this group was 6.5 years. There was a 24% increased incidence of second tumors. The estimated 25-year risk for developing a second cancer was 32%. The most frequent cancers were non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and thyroid cancer. There was a decreased incidence of lung cancer and smoking-related cardiovascular mortality. These authors speculated that second tumors were related to underlying immunologic defects.
Comments: Physicians taking care of patients with hairy cell leukemia should be aware of the increased risk for second cancers.
Reference: Hisada M, Chen BE, Jaffe ES, et al. Second cancer incidence and cause-specific mortality among 3104 patients with hairy cell leukemia: a population-based study. Journal of the National Cancer Institute 2007;99:215-222.
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