Chronic lymphocytic leukemia (CLL) is associated with perturbed immune function and increased risk for second primary malignancies (SPM). Ibrutinib and acalabrutinib (BTKi) are effective therapies for CLL resulting in partial restoration of immune function. The incidence of and risk factors for SPM in CLL patients receiving BTKi are not yet characterized. We retrospectively determined the incidence of SPM in CLL patients treated with ibrutinib or acalabrutinib at our institution between 2009 and 2017, assessed for association between baseline characteristics and SPM incidence, and compared the observed to expected cancer incidence among age, sex, and year matched controls without CLL. After a median of 44 months follow-up, 64/691 patients (9%) were diagnosed with SPM (excluding non-melanoma skin cancer [NMSC]). The 3-year cumulative incidence rate was 16% for NMSC and 7% for other SPM. On multivariable analysis, smoking was associated with increased SPM risk (HR 2.8 [95% CI: 1.6–4.8]) and higher baseline CD8 count was associated with lower SPM risk (HR 0.9 for 2-fold increase [95% CI: 0.8–0.9]). The observed over expected rate of SPM was 2.2 [95% CI: 1.7–2.9]. CLL patients treated with BTKi remain at increased risk for SPM, and secondary cancer detection is an important consideration in this population.
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Conflict of interest
KAR has consulted for Acerta Pharma, AstraZeneca, and Pharmacyclics, has received travel funding from Astra Zeneca, and has received research funding from Genentech, AbbVie, and Janssen. SAB has consulted for Pharmacyclics and Janssen. MRG has served on an advisory committee for Acerta Pharma. SMJ has received research funding from Pharmacyclics. JCB has consulted for Janssen, received travel support from TG Therapeutics, Janssen, Pharmacyclics, and Gilead, served on speakers bureau for Gilead, Pharmacyclics, Janssen, Novartis, and TG Therapeutics, and received research funding from Gilead, Acerta, BeiGene, Janssen, Genentech, Pharmacyclics, and TG Therapeutics. JAW has consulted for Janssen, Pharmacyclics, AstraZeneca, and Arqule and has received research funding from Janssen, Pharmacyclics, Loxo, and Arqule. DAB, YH, JLF, ASR, DHO, EMB, and KJM have no relevant competing interests.
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Bond, D.A., Huang, Y., Fisher, J.L. et al. Second cancer incidence in CLL patients receiving BTK inhibitors. Leukemia (2020). https://doi.org/10.1038/s41375-020-0987-6