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. 2015 Oct 1;33(28):3096-104.
doi: 10.1200/JCO.2014.60.2094. Epub 2015 Aug 3.

Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma

Clara J K Lam  1 , Rochelle E Curtis  2 , Graça M Dores  2 , Eric A Engels  2 , Neil E Caporaso  2 , Aaron Polliack  2 , Joan L Warren  2 , Heather A Young  2 , Paul H Levine  2 , Angelo F Elmi  2 , Joseph F Fraumeni Jr  2 , Margaret A Tucker  2 , Lindsay M Morton  2
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Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma

Clara J K Lam et al. J Clin Oncol. .

Abstract

Purpose: Previous studies have reported that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing cutaneous melanoma; however, risks associated with specific treatments and immune-related risk factors have not been quantified.

Patients and methods: We evaluated second melanoma risk among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 and included in the Surveillance, Epidemiology, and End Results-Medicare database. Information on NHL treatments, autoimmune diseases, and infections was derived from Medicare claims.

Results: A total of 202 second melanoma cases occurred among survivors of NHL, including 91 after chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and 111 after other NHL subtypes (cumulative incidence by age 85 years: CLL/SLL, 1.37%; other NHL subtypes, 0.78%). Melanoma risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with or without rituximab (n=18: hazard ratio [HR], 1.92; 95% CI, 1.09 to 3.40; n=10: HR, 2.92; 95% CI, 1.42 to 6.01, respectively). Significantly elevated risks also were associated with T-cell activating autoimmune diseases diagnosed before CLL/SLL (n=36: HR, 2.27; 95% CI, 1.34 to 3.84) or after CLL/SLL (n=49: HR, 2.92; 95% CI, 1.66 to 5.12). In contrast, among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or with T-cell/B-cell immune conditions. Generally, infections were not associated with melanoma risk, except for urinary tract infections (CLL/SLL), localized scleroderma, pneumonia, and gastrohepatic infections (other NHLs).

Conclusion: Our findings suggest immune perturbation may contribute to the development of melanoma after CLL/SLL. Increased vigilance is warranted among survivors of NHL to maximize opportunities for early detection of melanoma.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Cumulative incidence of subsequent melanoma after non-Hodgkin lymphoma by subtype, (B) by fludarabine treatment among chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) survivors, and (C) by diagnosis of T-cell–activating autoimmune conditions among CLL/SLL survivors.
See this image and copyright information in PMC

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