The longevity of patients with chronic lymphocytic leukemia (CLL) has improved progressively over the past decades, making it essential to understand long-term health outcomes, such as second primary malignancies (SPMs). Therefore, this nationwide, population-based study assessed the risk of SPM development in CLL patients diagnosed during 1989-2019 in the Netherlands compared to the expected number of malignancies in an age-, sex-, and period-matched group from the general Dutch population. In 24,815 CLL patients followed for 162,698.49 person-years, 4369 SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.63 (95% confidence interval [CI] 1.59–1.68). This elevated risk was observed for solid (SIR, 1.67; 95% CI, 1.65–1.75) and hematological SPMs (SIR 1.42; 95% CI, 1.24–1.62). The highest risk for SPMs was noted beyond five years post-diagnosis (SIR, 1.70; 95% CI, 1.62–1.77), for male individuals (SIR, 1.70; 95% CI, 1.64–1.77), and patients aged 18–69 years (SIR, 1.92; 95% CI, 1.79–2.05). The risk of SPMs was higher in CLL patients who received anti-neoplastic therapy (SIR, 2.12; 95% CI, 1.96–2.28), as compared with those who did not (SIR, 1.58; 95% CI, 1.53–1.63). Routine surveillance activities and tailored interventions to counteract the increased morbidity and excess mortality associated with SPMs are essential for improving long-term outcomes in CLL patients.
在过去几十年中，慢性淋巴细胞白血病（CLL）患者的生存期逐渐延长，这使得理解其长期健康结局（如继发性原发恶性肿瘤[SPMs]）变得至关重要。为此，这项全国性、基于人群的研究评估了1989年至2019年间荷兰确诊的CLL患者发生SPM的风险，并与荷兰一般人群中年龄、性别和时期匹配组的预期恶性肿瘤发病率进行了比较。在对24,815名CLL患者进行的162,698.49人年随访中，共诊断出4369例SPM，其标准化发病率比（SIR）为1.63（95%置信区间[CI] 1.59–1.68）。实体肿瘤（SIR 1.67；95% CI 1.65–1.75）和血液系统SPM（SIR 1.42；95% CI 1.24–1.62）的风险均显著升高。诊断后五年以上（SIR 1.70；95% CI 1.62–1.77）、男性（SIR 1.70；95% CI 1.64–1.77）以及18-69岁患者（SIR 1.92；95% CI 1.79–2.05）的SPM风险最高。与未接受治疗的患者相比，接受过抗肿瘤治疗的CLL患者发生SPM的风险更高（SIR 2.12；95% CI 1.96–2.28 vs. SIR 1.58；95% CI 1.53–1.63）。为改善CLL患者的长期预后，开展常规监测并采取针对性干预措施以应对SPM相关的发病率和超额死亡率至关重要。
肿瘤(癌症)患者之家