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Epidemiology

Increased prevalence of prior malignancies and autoimmune diseases in patients diagnosed with chronic myeloid leukemia

Leukemia volume 30, pages 1562–1567 (2016)Cite this article

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Abstract

We recently reported an increased incidence of second malignancies in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKI). To elucidate whether this increase may be linked, not to TKI but rather to a hereditary or acquired susceptibility to develop cancer, we estimated the prevalence of malignancies, autoimmune disease (AD) and chronic inflammatory disease (CID) in CML patients prior to their CML diagnosis. Nationwide population-based registers were used to identify patients diagnosed with CML in Sweden 2002–2012 and to estimate the prevalence of other malignancies, AD and CID prior to their CML diagnosis. For each patient with CML, five matched controls were selected from the general population. Conditional logistic regression was used to calculate odds ratios (OR). Nine hundred and eighty-four CML patients were assessed, representing more than 45 000 person-years of follow-up. Compared with matched controls, the prevalence of prior malignancies and AD was elevated in CML patients: OR 1.47 (95% confidence interval (CI) 1.20–1.82) and 1.55 (95% CI 1.21–1.98), respectively. No associations were detected between CML and previous CID. An increased prevalence of other malignancies and AD prior to the diagnosis of CML suggest that a hereditary or acquired predisposition to cancer and/or autoimmunity is involved in the pathogenesis of CML.

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Acknowledgements

This study was supported by grants from the Emil Andersson Research Fund and the Nordic CML Study Group. We want to thank the data managers at the respective Regional Cancer Centers as well as all Swedish hematologists who have carefully reported patients to the CML Register.

Author contributions

AS, MH, LS and JR provided conception and design, patient material, data collection, data interpretation and manuscript writing. NG provided conception and design, data collection, data interpretation and manuscript writing. FS provided data analysis and interpretation, statistical methodology and manuscript writing. MB, AD, ML, BM, UO-S and HW provided patient material, data collection and manuscript writing. SW-J provided conception and design, data analysis and manuscript writing. All authors contributed with critical revision of the manuscript.

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Authors and Affiliations

  1. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    N Gunnarsson, S Wållberg-Jonsson & A Själander

  2. Department of Medical Science and Division of Hematology, University Hospital, Uppsala, Sweden

    M Höglund & U Olsson-Strömberg

  3. Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden

    L Stenke & M Björkholm

  4. Regional Cancer Centre, Uppsala-Örebro, Sweden

    F Sandin & M Lambe

  5. Department of Hematology, University Hospital, Linköping, Sweden

    A Dreimane

  6. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    M Lambe

  7. Department of Hematology, University Hospital, Umeå, Sweden

    B Markevärn

  8. Department of Hematology, Sahlgrenska University Hospital, Göteborg, Sweden

    H Wadenvik

  9. Department of Hematology and Vascular Disorders, Skåne University Hospital, Lund, Sweden

    J Richter

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  1. N Gunnarsson
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  2. M Höglund
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Corresponding author

Correspondence to N Gunnarsson.

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Competing interests

AS had a consulting role for ARIAD. JR has received honoraria from ARIAD, Bristol-Myers Squibb and Novartis. MB have a consulting role for Roche, Tolero Pharmaceuticals and Nordic Nanovector, and received honoraria from Roche, Tolero Pharmaceuticals and Nordic Nanovector. ML have stock ownership in AstraZeneca and Pfizer. SW-J received honoraria from MDS. MH has a consulting role for Akinion Pharmaceuticals and has received honoraria from Janssen-Cilag. The remaining authors declare no competing financial interests.

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Gunnarsson, N., Höglund, M., Stenke, L. et al. Increased prevalence of prior malignancies and autoimmune diseases in patients diagnosed with chronic myeloid leukemia. Leukemia 30, 1562–1567 (2016). https://doi.org/10.1038/leu.2016.59

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