Second Neoplasms in Italian Patients with Hairy Cell Leukemia after Treatment with Cladribine: A Multicenter Investigation and Literature Review

Author:

Criscuolo Marianna1ORCID,Tosti Maria Elena2ORCID,Broccoli Alessandro34ORCID,Varettoni Marzia5ORCID,Maraglino Alessio Maria Edoardo6,Anastasia Antonella7,Cantonetti Maria8,Trentin Livio9ORCID,Kovalchuk Sofia10,Orsucci Lorella11,Deodato Marina12,Spolzino Angelica1314,Volpetti Stefano15,Annibali Ombretta16,Storti Sergio17,Stelitano Caterina18,Marchesi Francesco19ORCID,Morè Sonia20,Fianchi Luana1,Falini Brunangelo21,Pulsoni Alessandro22ORCID,Tiacci Enrico21,Zinzani Pier Luigi34ORCID,Pagano Livio123ORCID

Affiliation:

1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

2. Istituto Superiore Sanità, 00161 Rome, Italy

3. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy

4. Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40126 Bologna, Italy

5. Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy

6. Oncohematology Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy

7. Department of Hematology, ASST Spedali Civili, 25123 Brescia, Italy

8. Dipartimento di Oncoematologia Policlinico Tor Vergata, Università Tor Vergata, 00133 Rome, Italy

9. Division of Haematology and Clinical Immunology, University of Padova, 35137 Padua, Italy

10. SOD C Ematologia, AOU Careggi, 50134 Firenze, Italy

11. S.C. Ematologia, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy

12. Divisione di Ematologia, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy

13. Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, 43125 Parma, Italy

14. Oncoematologia, Istituto Oncologico Veneto IOV-IRCSS, 31033 Castelfranco Veneto, Italy

15. Clinica Ematologia, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy

16. Hematology and Stem Cell Transplantation Unit, Campus Bio-Medico University, 00128 Rome, Italy

17. UOC Oncoematologia Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso—Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy

18. Divisione di Ematologia, Azienda Ospedaliera “Bianchi Melacrino Morelli”, 89125 Reggio Calabria, Italy

19. Haematology and Stem Cell Transplantation Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy

20. Clinica di Ematologia, AOU delle Marche, 60126 Ancona, Italy

21. Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy

22. Divisione di Ematologia, Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy

23. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Abstract

Concern has emerged about the prevalence of second cancers among patients with hairy cell leukemia (HCL) treated with purine analogs. We investigated 513 patients with HCL treated with cladribine over the last 30 years at 18 Italian centers and calculated their standardized incidence ratios (SIRs). We identified 24 patients with a second cancer diagnosed at a median time from treatment with cladribine of 59.9 months (range: 9.2–169.7 months). All patients with solid neoplasms presented with a limited-stage disease, except four cases of locally advanced cancer; multiple myeloma patients had a smoldering disease, while lymphoma patients had stage Ie and stage IV diseases. Response to therapy was complete in 19 cases; 1 patient is still receiving treatment for a relapsing bladder disease, while 2 patients progressed during treatment and died. These two patients died from unrelated causes: one from infection and one due to surgery complications. The median OS from HCL was 98.5 months (range: 38.4–409.2 months), while the median OS from second cancer was 27.6 months (range: 1–117.8 months). The SIR was 0.86 (95% CI: 0.54–1.30) for males and 1.13 (95% CI: 0.36–2.73) for females: no statistically significant differences were highlighted. We were not able to demonstrate an excess of second cancer or a significant association with the specific studied neoplasm.

Publisher

MDPI AG

Reference30 articles.

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