ASH 2024: First-Line Treatment Choice Impacts Risk for Other Malignancies in CLL and SLL

Patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) have previously been shown to be at increased risk for developing other malignancies relatively to the general population. Chemoimmunotherapy has historically been the mainstay of treatment for CLL and SLL, though, which is also known to be associated with increased risks for other cancers. As newer therapies — including targeted therapies and monoclonal antibodies — have become the standard of care, investigators sought to compare the incidence of other cancers in patients treated with newer therapies or chemoimmunotherapy, or managed with active surveillance.

This analysis, presented by Foundation grantee Helan Ma, MD of the University of California, Irvine, examined records from 5244 patients with CLL or SLL in the Department of US Veteran Affairs Central Cancer Registry (VACCR) who were diagnosed during or after 2016. Two thirds of patients were managed with active surveillance; 25% and 4% were managed with targeted therapies or single-agent monoclonal antibodies, respectively, and 6% with first-line chemoimmunotherapy. The median follow-up was 3.19 years, during which time 10% of patients were diagnosed with another cancer.

After adjusting for age at diagnosis, race, and tobacco and alcohol use, first-line treatment with chemoimmunotherapy was associated with a 2.4-fold increased risk for other cancers compared with those on active surveillance. No increase was seen, though, in the risk for other cancers with either targeted therapies or monoclonal antibodies when compared with active surveillance.

The authors noted that similar analyses are ongoing at other centers across the country.