Archibald William J, Meacham Philip J, Williams AnnaLynn M, Baran Andrea M, Victor Adrienne I, Barr Paul M, Sahasrahbudhe Deepak M, Zent Clive S
School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Leuk Res. 2018 Aug;71:43-46. doi: 10.1016/j.leukres.2018.07.003. Epub 2018 Jul 6.
Melanoma is significantly more common and is associated with a poorer prognosis in patients with an underlying B-cell malignancy. This study reports on the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) and a subsequent diagnosis of melanoma. In the Wilmot Cancer Institute CLL cohort, which includes 470 patients followed for 2849 person-years, 18 patients (3.8%) developed 22 melanomas. Fourteen melanomas were invasive, a significantly higher rate as compared with the age and sex matched general population (standardized incidence ratio [SIR] 6.32 (95% CI 3.45; 10.60). Melanomas were most often detected (n = 15; 68.2%) through active surveillance in a dermatology clinic. Most melanomas (n = 17; 77.3%) were detected at a non-advanced stage (pathological stage grouping < III). The most common management was wide local excision without sentinel lymph node biopsy (n = 13, 59.1%). Management for the 4 (18.2%) patients with metastatic disease included the immune checkpoint inhibitor (ICI) pembrolizumab (n = 1), systemic chemotherapy with dacarbazine (n = 1), and palliative care (n = 2). The patient treated with ICI is in sustained remission of her melanoma after 23 cycles of therapy while her TP53 disrupted CLL continues to respond to ibrutinib therapy. We conclude that patients with CLL may benefit from active surveillance for melanoma leading to early excision of locally-manageable disease. In patients with metastatic melanoma, combined treatment with targeted kinase inhibitors and ICIs can be successful and tolerable. Larger prospective studies should be considered to further evaluate these approaches.
黑色素瘤在患有潜在B细胞恶性肿瘤的患者中明显更为常见，且与较差的预后相关。本研究报告了慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL）患者及随后诊断为黑色素瘤的患者的管理情况。在威尔莫特癌症研究所的CLL队列中，包括470例随访2849人年的患者，18例患者（3.8%）发生了22例黑色素瘤。14例黑色素瘤为浸润性，与年龄和性别匹配的一般人群相比，发生率显著更高（标准化发病比[SIR]为6.32（95%CI 3.45；10.60））。黑色素瘤最常（n = 15；68.2%）通过皮肤科诊所的主动监测发现。大多数黑色素瘤（n = 17；77.3%）在非晚期阶段（病理分期分组<III）被发现。最常见的治疗方法是广泛局部切除，不进行前哨淋巴结活检（n = 13，59.1%）。4例（18.2%）转移性疾病患者的治疗包括免疫检查点抑制剂（ICI）派姆单抗（n = 1）、达卡巴嗪全身化疗（n = 1）和姑息治疗（n = 2）。接受ICI治疗的患者在23个周期的治疗后黑色素瘤持续缓解，而其TP53基因破坏的CLL继续对伊布替尼治疗有反应。我们得出结论，CLL患者可能受益于对黑色素瘤的主动监测，从而早期切除可局部治疗的疾病。对于转移性黑色素瘤患者，联合使用靶向激酶抑制剂和ICI治疗可能成功且耐受性良好。应考虑进行更大规模的前瞻性研究以进一步评估这些方法。
