Pelin AYTAN, Mahmut YERAL, Mutlu KASAR, Nurhilal BUYUKKURT, Ilknur KOZANOGLU, Hakan OZDOGU, Can BOGA, Cigdem GEREKLİOGLU, Asli KORUR, Suheyl ASMA

The clinicopathologic features of multiple primary malignancies in hematology: A cross sectional descriptive study

In Turkish literature there are very few studies regarding multiple primary malignancies (MPM). The aim of this study was to analyze the synchronous and the metachro-nous malignancies that occurred with a hematologic malignancy. All the patients with a hematologic malignancy were enrolled in this cross-sectional, definitive retro-spective study. Data were obtained from the medial records. Patients’ characteristics including demographic features, treatment protocols and overall survival (OS) were recorded. Among 663 patients with a hematologic malignancy, there were 26 patients with MPMs (3.9%). Synchronous malignancies constitute 0.9% and metachronous malignancies were present in 3%. In men diffuse large B-cell lymphoma (DLBCL) and non-small cell lung carcinoma (NSCLC) and in women breast and acute myeloid leukemia were the most common primary and secondary MPMs respectively. The mean cumulative OS of all patients with MPMs was 246.3±33.4 months and the 5 years-OS was 91.3%. In synchronous MPMs the most frequent concomitant tumors were DLBCL and NSCLC. In metachronous tumors the median time interval between first and second malignancies was 69.5 months (range: 31-312). In four patients there were three MPMs. After radiotherapy three patients developed breast, thyroid and skin cancers and in one patient who received radioiodine for the treatment of thyroid carcinoma, DLBCL had developed. The chemotherapeutic agents applied for the primary malignancies consisted of alkylating agents, antimetabolites, anthracyclines, topoisomerase II inhibitors, monoclonal antibodies and mitotic inhibitors. In 75% of the patients with DLBCL who had received R-CHOP chemotherapy regimen, NSCLC had developed during the follow-up period. In conclusion secondary malignancies with hematologic malignancies are not rare and the clinicians should keep the possibility of secondary malignancies in mind and be suspicious during diagnostic evaluations. Warning with regard to the risk of development of secondary malignancies due to the primary treatment should be given to any patient with a hematologic malignancy.

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1. Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer. 1932;16:1358-414.

2. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: Prevalence Trajectories and Comorbidity Burden among Older Cancer Survivors in the United States Cancer Epidemiol Biomarkers Prev. 2016;25:1029-36

3. Turkish Republic, Ministry of Health, Public Health Institution National Cancer Control Plan 2013-2018, https://www.iccp-portal.org/system/files/plans/Ulusal_Kanser_Kontrol_Plani_2013_2018.pdf, access date 31.08.2019

4. Dores GM, Metayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin’s disease: A population-based evaluation over 25 years. J Clin Oncol. 2002;20:3484-94.

5. Hodgson DC, Gilbert ES, Dores GM, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin’s lymphoma. J Clin Oncol. 2007;25:1489-97.

6. Ng AK, Travis LB. Subsequent malignant neoplasms in cancer survivors. Cancer J. 2008;14:429-34.

7. Inskip PD, Curtis RE. New malignancies following childhood cancer in the United States, 1973-2002. Int J Cancer 2007;121:2233-40

8. Tanba K, Chinen Y, Uchiyama H, et al. Prognostic impact of a past or synchronous second cancer in diffuse large B cell lymphoma. Blood Cancer J. 2018;8:1.

9. Howe HL (ed). A Review of the Definition for Multiple Primary Cancers in the United States. Workshop Proceedings From December 4–6, 2002, in Princeton, New Jersey. Springfield (IL): North American Association of Central Cancer Registries, 2003.

10. Ganz PA. Late effects of cancer and its treatment. Semin Oncol Nurs. 2001;17:241-8.

11. Olsen JH, Garwicz S, Hertz H, et al. Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries. BMJ. 1993;307:1030-6.

12. Jenkinson HC, Hawkins MM, Stiller CA, et al. Long-term population-based risks of second malignant neoplasms after childhood cancer in Britain. Br J Cancer. 2004;91:1905-10.

13. Dores GM, Cote TR, Travis LB. New malignancies following Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma. In: Curtis R, Freedman D, Ron F et al.New malignancies among cancer survivors: SEER cancer registries, 1973-2000 (NIH Publ. No: 05-5302). 397, 2006, National Institutes of Health, Bethesda MD

14. Demirci U, Ozdemir N, Benekli M, et al. Lymphoproliferative disorders in multiple primary cancers. Asian Pac J Cancer Prev. 2012;13:383-6.

15. Kılçıksız SÇ, Kaynak C, Eşki E, et al. Çok primerli ve tek primerli kanser olguları: İzmir kanser kayıt merkezi verilerinden hastane tabanlı bir inceleme. Türk Onkoloji Dergisi 2007;22:55-62.

16. Gursel B, Meydan D, Özbek N, et al. Multiple primary malignant neoplasms from the black sea region of Turkey. J Int Med Res. 2011;39:667-74

17. Jemal A, Ward EM, Thun MJ. Epidemiology of cancer; cancer statistics. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 7th ed. CD-Room. Lippincott Williams& Wilkins. 530 Walnut Street Philadelphia PA 19106 USA LWW.com. 2005. Chapter 11; Section 2

18. van Leeuwen FE TL. Second cancers. In. Cancer: principles and practice of oncology. 7th ed. DeVita VT HSRS, Ed. Philadelphia, Lippincott Williams &Wilkins, 2005; 2572-602

19. Bhatia S, Blatt J, Meadows A. Late effects of childhood cancer and its treatment. In Principles and Practice of Pediatric Oncology. 5th ed. Pizzo P PD, Ed. Philadelphia, Lippincott Williams & Wilkins, 2006;1490-514.

20. Iyer NG, Morris LG, Tuttle RM, et al. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer. 2011;117:4439-46

21. Travis LB, Holowaty EJ, Bergfeldt K, et al. Risk of leukemia after platinum-based chemotherapy for ovarian cancer. N Engl J Med. 1999;340:351-7

22. Cecen E, Bolaman Z. İkincil kanserler. UHOD, 2010;20:190-200.

23. Vega-Stromberg T Chemotherapy-induced secondary malignancies. J Infus Nurs. 2003;26:353-61.

24. Colvin M. Alkylating agents. In: Kufe DW, et al. (Eds). Holland-Frei Cancer Medicine (6th ed). Hamilton: BC Decker, 2003.

25. Travis LB, Gospodarowicz M, Curtis RE, et al.: Lung cancer following chemotherapy and radiotherapy for Hodgkin’s disease. J Natl Cancer Inst. 2002;94:182-92.

26. Swerdlow AJ, Schoemaker MJ, Allerton R, et al: Lung cancer after Hodgkin’s disease: a nested case-control study of the relation to treatment. J Clin Oncol 2001;19:1610-8,

27. Engin K. Cancers in multiple primary sites. Int Surg. 1994;79:33-7.