Research paperManagement of melanoma in patients with chronic lymphocytic leukemia
Introduction
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) is the most prevalent lymphoid malignancy in the United States, with approximately 140,000 people living with the disease [1]. Immune dysfunction is an early and clinically important complication of CLL [2]. Patients with CLL are at significantly increased risk of skin cancer including melanoma, and have a ∼2-fold increased risk of mortality from these second malignancies compared to patients without a preceding diagnosis of CLL [[3], [4], [5], [6], [7]]. As a result, patients with a diagnosis of CLL are often recommended to undergo routine skin cancer examinations because melanomas detected by health care providers or by a routine surveillance program have better outcomes than those who present due to symptomatic lesions [8]. In addition, for patients with metastatic melanoma, the introduction of immune checkpoint inhibitor (ICI) therapy has significantly improved outcomes. However, patients with a second malignancy were excluded from these clinical trials [9] so there is limited data on the efficacy of these treatments for metastatic melanoma in the CLL patient population. In this observational study, we investigated how melanomas were detected and managed in a single regional CLL patient population to provide data on the utility of active monitoring for melanoma and report that ICI could have a role in management of advanced disease in this population.
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Study subjects
The Wilmot Cancer Institute (WCI) CLL cohort includes all consenting CLL and clinically detected CLL immunophenotype monoclonal B cell lymphocytosis (MBL) patients diagnosed using standard criteria [10] managed at the University of Rochester Medical Center (URMC). This is an open cohort, where participants may enter and leave at any point, and information is collected while they are managed at WCI. All 470 CLL cohort patients seen in the WCI Lymphoma/CLL clinic between 1 May 2000 and 1
Results
A total of 470 patients (461 CLL, 9 MBL) contributed 2849.3 years of follow-up (Table 1). Except for younger age at diagnosis, the patient characteristics were typical for an unselected CLL population with no significant differences between patients with and without melanoma [16].
Eighteen (3.8%) of the 470 patients in the cohort had 22 melanomas detected during the observation period with 7 (33.3%) detected at the in situ stage (pathologic stage 0), 8 (38.1%) at pathologic stage I, 2 (9.5%) at
Discussion
To the best of our knowledge, this study is the first comprehensive analysis of the detection and treatment of melanoma in a clinical cohort of patients with CLL. We also report the successful treatment of metastatic melanoma with pembrolizomab in a patient with CLL on ibrutinib therapy.
Consistent with previously published data, our study found a significantly higher rate of detection of melanoma (SIR 6.32,95% CI 3.45–10.60) in CLL patients compared to an age and sex matched general population [
Acknowledgments
The authors would like to thank the consenting CLL patients who made the study possible.
Funding
This work was funded by the Cadregari Endowment at the University of Rochester’s Wilmot Cancer Institute.
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Chronic lymphocytic leukemia and second primary nonlymphoid malignancies: cytopathologic study of 17 cases
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