Really interesting article in the most recent issue of the journal Blood Advances. It's called "Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma: a Swedish population-based study."It looks at a large group of NHL patients over many years, and how often they get a second cancer. There's some good news in there for Follicular Lymphoma patients.
The study looked at two large databases (over 30,000 people in each). One contained information about patients in Sweden who were diagnosed with Non-Hodgkin's Lymphoma (of many different types, including FL) between 1993 and 2014. The other database represented the general population.
The purpose of the study was to compare how often NHL patients are diagnosed with a Secondary Primary Malignancy (or SPM), compared to how many people in general are diagnosed with cancer. In other words, they want to see if receiving treatment for NHL made you more likely to get another cancer later on.
I want to stop here and emphasize something very important. This is a retrospective study -- one that looks backwards. It says a lot about people who were diagnosed with NHL between 8 and 29 years ago. It says less about people who were diagnosed more recently, for some very important reasons, which I'll get into below. This is very important to keep in mind as you read. I know many of us have a tendency to let our minds go to the worst possible outcome (myself included). Resist that, please.
To get right to the results:
The study found that NHL patients diagnosed between 1993 and 2014 were about 42% more likely to get a solid tumor Secondary Primary Malignancy. NHL patients over 70 years old had a higher rate of SPM than younger patients. The rate of SPM for one specific blood condition was about 5 times higher than the general population. That blood condition is Myelodysplastic Syndrome (MDS), which often leads to another blood cancer, Acute Myeloid Leukemia (AML).
Remember, there's good news coming. Keep reading.
The results aren't really a surprise. We've known for a very long time that cancer treatment can cause secondary cancers. When I write about clinical trials, I often mention side effects -- things like lower blood counts, or nerve damage. Those are usually short-term side effects, which makes sense, because clinical trials only report side effects from a few years after the trial takes place. Secondary cancers are usually a longer-term side effect, and can show up years later -- if they happen at all. In this study, it was about 11% of patients that eventually developed a secondary cancer. And cancer is bad, obviously, but a 1 in 10 chance is much less worrisome than it might seem. And the MDS/AML was even smaller -- less than 1% of patients in the study.
So what's the good news?
Well, I see three pieces of good news from the article.
First, the rate of SPMs in the study held steady. In other words, the number of new cancers didn't get worse over time.
Second, while the rate of MDS/AML (the blood condition/blood cancer) increased overall for NHL, it actually DECREASED for Follicular Lymphoma. In the more recent years in the study, Follicular Lymphoma patients were about as likely as the general population to be diagnosed with this type of leukemia.
And that's the third bit of good news. The reason for this decrease, according to the researchers, is because Follicular Lymphoma patients are increasingly receiving non-chemotherapy treatments. From 1993 to 2014, the years of the study, that was most likely Rituxan. And even for those FL patients who received traditional chemo like CHOP or Bendamustine, it was often combined with Rituxan, which increased the time until another treatment was needed. Fewer treatments overall = fewer long-term side effects.
Think about that. As the researchers put it, there is an increasing number of non-chemotherpay options available for FL patients. For some of us with more aggressive versions of FL, immunochemotherapy (R-CHOP or B-R) is common. That's not a bad thing -- they work. For others of us, there are more non-chemo options available for first treatments. And for ALL of us, second and third treatments, when they are necessary, are increasingly likely to be non-chemo.
It's chemo and radiation that are most likely to cause the kind of DNA damage that might lead to a secondary cancer. Years ago, FL patients would likely get chemo, and then follow it up with more chemo if necessary. That's just not the case now.
Think about the options available to us: Rituxan and Obinutuzumab, R-Squared, CAR-T, inhibitors. Bispecifics, soon. None of them are traditional chemotherapy. They will all cause side effects -- short- and long-term -- but it seems like the number of secondary cancers as a result of treatment are likely to go down. It will be really interesting to see a retrospective study 10 or 20 years from now, when those of us who have gone through treatment in the last few years, and in the few years to come, are studied for long-term side effects.
Of course, this is a good time to remind everyone that I'm not a doctor or a cancer researcher. This is just me making an educated guess. But I'm also repeating what some very smart cancer researchers said, too, about FL. So I feel good saying it.
I was hesitant about writing about this, to be honest. I don't like to think (or write) about negative things like secondary cancers. But I like to write about hope, which is about good things that might happen in the future.
Hope won out with this one.
One final thing -- I'm guessing most of you are like me when it comes to cancer. We're constantly on the lookout for anything that doesn't seem right. The SPMs that were most common in this study were things like skin cancers and colo-rectal cancers. I probably don't need to tell you to do skin checks and get colonoscopies, but it's a good reminder. Prevent the cancers that you can, and catch them through early detection.
In the meantime, stay well, and stay hopeful.
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