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Review
. 2024 Feb;13(2):e230119.
doi: 10.57264/cer-2023-0119. Epub 2024 Jan 31.

Assessment of second primary malignancies among treated and untreated patients with chronic lymphocytic leukemia using real-world data from the USA

Sikander Ailawadhi  1 , Arliene Ravelo  2 , Carmen D Ng  2 , Bonny Shah  3 , Neil Lamarre  3 , Rongrong Wang  2 , Katherine Eakle  2 , Juliana Ml Biondo  2
Affiliations
Review

Assessment of second primary malignancies among treated and untreated patients with chronic lymphocytic leukemia using real-world data from the USA

Sikander Ailawadhi et al. J Comp Eff Res. 2024 Feb.

Abstract

Aim: Improved management of chronic lymphocytic leukemia (CLL) has resulted in a growing population of CLL survivors; these patients have a higher risk of developing second primary malignancies (SPMs) versus the general population. This retrospective cohort study aims to assess the timing, frequency, incidence and types of SPMs in treated and untreated patients with CLL in the USA, using the Surveillance, Epidemiology, and End Results (SEER) Medicare database, which links a nationally representative cancer registry with Medicare claims data. Patients & methods: Patients aged ≥66 years with newly diagnosed CLL between 1 January 2010 and 31 December 2016, who were enrolled in Parts A and B of Medicare for ≥12 months pre-diagnosis of CLL were selected from the database. Patients were assessed for ≥36 months until the end of continuous enrollment in Medicare Parts A, B and D, a switch to a health maintenance organization, death, or end of the study period (December 2019). Results: Of 3053 patients included in the analyses, 620 (20.3%) were treated and 2433 (79.7%) were untreated within 36 months of diagnosis. Overall, 638 (20.9%) patients developed a SPM, 26.8% of patients in the treated cohort and 19.4% of patients in the untreated cohort. The most common SPMs for both cohorts were squamous cell carcinoma and acute myeloid leukemia. Among the 166 treated patients who developed a SPM, a greater proportion developed their first SPM after treatment initiation versus those who developed their first SPM prior to treatment initiation (p < 0.001). A significantly lower percentage of patients who received targeted therapy developed a SPM (p < 0.05) versus patients treated with anti-CD20 + chemotherapy. Conclusion: Findings indicate that treatment type and timing can affect SPM development in patients with CLL. Combined with previous findings, this can help inform best practices in monitoring for SPM in patients with CLL.

Keywords: chronic lymphocytic leukemia; management; real-world; second primary malignancies; treatment.

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Conflict of interest statement

Competing interests disclosure

S Ailawadhi: GSK, Sanofi, BMS, Takeda, Beigene, Pharmacyclics, Amgen, Janssen, AstraZeneca, Regeneron – consultancy; GSK, BMS, Pharmacyclics, Amgen, Janssen, Cellectar, Xencar, AbbVie – research funding. A Ravelo, K Eakle: Genentech – current employment; F. Hoffmann-La Roche Ltd – current holder of individual stocks in a privately-held company and current holder of stock options in a privately-held company. CD Ng: Genentech – current employment; F. Hoffmann-La Roche Ltd – current equity holder in publicly traded company. B Shah: nothing to disclose. N Lamarre: Genesis Research – current employment. R Wang: Genentech – current employment; F. Hoffmann-La Roche Ltd – current holder of individual stocks in a privately-held company. JML Biondo: Genentech – current employment; F. Hoffmann La Roche Ltd – current holder of individual stocks in a privately held company and current holder of stock options in a privately held company. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.. Patient attrition.
*Per the SEER-Medicare data use agreement and the Research Data Assistance Center CMS cell size suppression policy, any instances where there are fewer than 11 patients for a particular characteristic or variable have been described as such to eliminate potential patient re-identification. CLL: Chronic lymphocytic leukemia; HMO: Health Maintenance Organization; ICD: International Classification of Diseases; SEER: Surveillance, Epidemiology, and End Results; SPM: Second primary malignancy.
Figure 2.
Figure 2.. Time from diagnosis to SPM accounting for censoring (in months).
SPM: Secondary primary malignancy.
See this image and copyright information in PMC

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