Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Haematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMJ Open. 2022 Sep 1;12(9):e061699. doi: 10.1136/bmjopen-2022-061699.
Survivors of diffuse large B-cell lymphoma (DLBCL) are at an increased risk of developing second primary malignancies. However, the risk of secondary acute myeloid leukaemia (sAML) has not been previously described in detail, and the outcomes of patients with sAML are also undiscovered compared with their de novo counterparts (de novo acute myeloid leukaemia, dnAML).
This study is a retrospective database study.
A total of 70 280 patients with primary DLBCL, diagnosed between 2000 and 2016, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Another cohort with dnAML matching with sAML was also obtained from SEER database.
The standardised incidence ratio was 6.23 (95% CI: 5.50 to 7.03) for sAML among survivors of DLBCL. The estimated cumulative incidence of sAML was 0.61% 15 years after the diagnosis of DLBCL. Patients aged 60-74 years were more likely to have sAML than those <60 years (subdistribution HR (sHR)=1.417; 95% CI: 1.087 to 1.850), whereas patients aged ≥75 years were less likely to have sAML (sHR=0.648; 95% CI: 0.452 to 0.930). Patients with advanced-stage DLBCL were more prone to sAML than those with early-stage disease (sHR=1.307; 95% CI: 1.012 to 1.690). There was a significant difference of survival between patients with dnAML and those with sAML (HR=1.25; 95% CI: 1.01 to 1.53).
The risk of developing sAML after DLBCL is substantial. Patients aged 60-74 years and with advanced-stage are more prone to sAML. And, compared with their dnAML counterparts, patients with sAML have a worse prognosis.
弥漫性大 B 细胞淋巴瘤 (DLBCL) 幸存者发生第二原发性恶性肿瘤的风险增加。然而，之前并未详细描述继发性急性髓系白血病 (sAML) 的风险，并且与初发性急性髓系白血病 (dnAML) 相比，sAML 患者的结局也尚未被发现。
本研究是一项回顾性数据库研究。
从监测、流行病学和最终结果 (SEER) 数据库中确定了 70280 名 2000 年至 2016 年间诊断为原发性 DLBCL 的患者。还从 SEER 数据库中获得了与 sAML 相匹配的 dnAML 队列。
在 DLBCL 幸存者中，sAML 的标准化发病比为 6.23（95%CI：5.50 至 7.03）。诊断为 DLBCL 后 15 年，sAML 的估计累积发生率为 0.61%。60-74 岁的患者比<60 岁的患者更容易发生 sAML（亚分布 HR（sHR）=1.417；95%CI：1.087 至 1.850），而≥75 岁的患者发生 sAML 的可能性较小（sHR=0.648；95%CI：0.452 至 0.930）。晚期 DLBCL 患者比早期疾病患者更容易发生 sAML（sHR=1.307；95%CI：1.012 至 1.690）。dnAML 患者与 sAML 患者的生存差异有统计学意义（HR=1.25；95%CI：1.01 至 1.53）。
DLBCL 后发生 sAML 的风险相当大。60-74 岁和晚期患者更容易发生 sAML。与 dnAML 患者相比，sAML 患者的预后更差。
