Second primary cancers in patients with acute lymphoblastic, chronic lymphocytic and hairy cell leukaemia

Research output: Contribution to journalArticle


Improvement of survival in lymphocytic leukaemia has been accompanied by the occurrence of second primary cancer (SPCs). Based on Swedish Family Cancer Database, we applied bi-directional analyses in which relative risks (RRs) were calculated for any SPCs in patients with chronic lymphocytic leukaemia (CLL), acute lymphoblastic leukaemia (ALL) and hairy cell leukaemia (HCL) and the risks of these leukaemias as SPCs. After CLL, RRs were significant for 20 SPCs, and high for skin squamous cell cancer (24·58 for in situ and 7·63 for invasive), Merkel cell carcinoma (14·36), Hodgkin lymphoma (7·16) and Kaposi sarcoma (6·76). Conversely, 15 CLL cancer pairs were reciprocally increased. The increased risks were reciprocal for ALL and four cancers. RR for ALL was 15·35 after myeloid neoplasia. HCL showed reciprocally increased RRs with non-Hodgkin lymphoma and melanoma. The concordance between RRs for bi-directional associations between CLL and different cancers, and HCL and different cancers was highly significant. For CLL (also for HCL), the bi-directional risks with skin cancers and other immune-related cancers suggest the probable involvement of immune dysfunction. For ALL, treatment may contribute to risks of multiple SPCs. Increased risk of ALL after haematological neoplasms may indicate bone marrow dysfunction. These findings may help guide treatment decisions and prognostic assessment.


External organisations
  • German Cancer Research Centre
  • Heidelberg University
  • Institute of Cancer Research London
  • Icahn School of Medicine at Mount Sinai
  • Shimane University
  • University of Helsinki
  • Helsinki University Central Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • B cell leukaemia, bi-directional risk, immune suppression, mechanistic implication, second cancers
Original languageEnglish
Pages (from-to)232-239
JournalBritish Journal of Haematology
Issue number2
Early online date2019 Jan 31
Publication statusPublished - 2019
Publication categoryResearch