Second primary malignancy risk after Hodgkin lymphoma treatment among HIV-uninfected and HIV-infected survivors

Abstract

We compared secondary primary malignancy risk (SPM) in HIV-uninfected and HIV-infected Hodgkin lymphoma (HL) survivors. We used data from the California Cancer Registry on patients diagnosed with HL from 1990 to 2015 (all ages included), and standardized incidence ratios (SIRs) and multivariable competing risk models for analyses. Of 19,667 survivors, 735 were HIV-infected. Compared with the general population, the risk of SPM was increased by 2.66-fold in HIV-infected and 1.92-fold in HIV-uninfected survivors. Among HIV-infected survivors, median time to development of SPM was shorter (5.4 years) than in HIV-uninfected patients (8.1 years). Additionally, the highest risk of SPM was observed <2 years after diagnosis in HIV-infected survivors (SIR = 4.47), whereas risk was highest ≥20 years after diagnosis (SIR = 2.39) in HIV-uninfected survivors. The risk of SPMs persisted for decades and was higher among HIV-infected survivors, suggesting that these patients should benefit from long-term surveillance and cancer prevention practices.

Keywords:

• Hodgkin lymphoma
• second primary malignancy
• HIV
• population-based

Acknowledgments

The authors thank Dr Aaron S. Rosenberg (UC Davis) for his contribution to this study.

Author contributions

Conception and design: RA, THMK, AB; Acquisition of data: THMK, AB, TW; Data analysis: AB, QL; Drafting of the manuscript: RA; Final review and approval of the manuscript: All authors.

Disclosure statement

The authors declare no conflict of interests.

Additional information

Funding

Dr Keegan was supported by the Rich and Weissman Family Lymphoma and Survivorship Fund St. Baldrick’s Research Grant. Dr Abrahão’s work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number T32HP30037 for Research in Primary Care. Dr Wun was supported by UL1 0000860, National Center for Advancing Translational Science (NCATS), National Institute of Health.