Risk of Secondary Malignancy in CLL Patients Treated with Novel Targeted Agents

Background: The introduction of novel targeted agents that inhibit specific cellular pathways has improved the prognosis of chronic lymphocytic leukemia (CLL) patients. CLL patients have a higher risk of secondary malignancies, but this risk has not yet been defined for patients treated with targete...

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Published in:Blood 2020-11, Vol.136 (Supplement 1), p.46-47
Main Authors: Eversman, Anna, Cao, Shufen, Boughan, Kirsten M, Gallogly, Molly M, Malek, Ehsan, Metheny, Leland, O'Brien, Timothy E., Otegbeye, Folashade, Cooper, Brenda W., Fu, Pingfu, de Lima, Marcos, Caimi, Paolo F
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Language:English
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Summary:Background: The introduction of novel targeted agents that inhibit specific cellular pathways has improved the prognosis of chronic lymphocytic leukemia (CLL) patients. CLL patients have a higher risk of secondary malignancies, but this risk has not yet been defined for patients treated with targeted agents, including inhibitors of BTK, PI3K or BCL2. Methods: We conducted a retrospective cohort study of CLL patients managed at a large tertiary care center between 1994 and 2018. Patients were classified according to whether they were treated with cytotoxic chemotherapy alone, chemoimmunotherapy or if they received a targeted agent (BTK inhibitor, PI3K inhibitor, BCL2 inhibitor) during the course of their disease. Time to first secondary malignancy corresponds to time elapsed between CLL diagnosis and the earliest secondary malignancy. Cumulative incidence of secondary malignancy was estimated considering competing risk of death. Multivariable analysis of cumulative risk of secondary malignancies was performed using Gray's method. Survival analysis was done with the Kaplan Meier method, comparisons were done using log - rank. Results: 265 CLL patients received care at our institution, median age (range) at diagnosis was 62 years (28-94), 168 (63.4%) were male, 199 (82.9%) were white, and 107 (41.5%) had Rai stage 3 or 4 at diagnosis. Median follow up was 10.5 years. Treatment was prescribed for 185 (70.1%) patients, 33 (17.7%) patients received only chemotherapy, 110 (59.1%) received chemoimmunotherapy, and 43 (23.1%) received targeted agents in the course of their disease. Median time to treatment was 11 months (IQR 1 - 177). Patients who did not receive therapy had a shorter median follow up (8.5 years) compared with treated patients (11.8 years) (p =
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2020-140042