1 Dipartimento di Oncologia ed Ematologia Università di Modena Centro Oncologico Modenese, Policlinico Modena 2 Dipartimento di Oncologia, Ospedale Santo Spirito, Pescara 3 Dipartimento di Oncologia, Sezione Ematologia, Ospedale Santa Chiara, Pisa 4 Medicina Oncologica ed Ematologica, Ospedale Civile, Piacenza 5 Clinica Medica, IRCCS Policlinico San Matteo, Università di Pavia, Pavia 6 Divisione di Ematologia, Presidio Ospedali Riuniti Bianchi, Melacrino, Morelli, Reggio Calabria 7 Unità Operativa di Ematologia, Azienda Ospedaliera dell’Annunziata, Cosenza 8 Divisione di Ematologia, Presidio Ospedaliero A. Perrino, Brindisi 9 Divisione di Ematologia, Azienda Ospedaliera Papardo, Messina, Italy Correspondence: Stefano Sacchi, MD Dipartimento di Oncologia ed Ematologia, Università di Modena Centro Oncologico Modenese Policlinico, 41100 Modena, Italy. E-mail: ssacchi{at}unimo.it Background: Relatively little information is available on the incidence of secondary cancer in non-Hodgkin’s lymphoma. The aim of this long-term follow-up study was to determine the incidence, the time free of second tumors, and risk factors for developing secondary cancer in a homogeneous group of patients with non-Hodgkin’s lymphoma. Design and Methods: We evaluated a total of 563 patients with indolent non-Hodgkin’s lymphoma enrolled in Gruppo Italiano Studio Linfomi trials from 1988 to 2003. Results: After a median follow-up of 62 months, 39 patients (6.9%) developed secondary cancer: 12 myelodysplastic syndromes/acute myeloid leukemia, and 27 solid tumors. The overall standardized incidence ratio of secondary malignancy in patients with non-Hodgkin’s lymphoma was higher than the risk of malignancy in the general population. The standardized incidence ratio was elevated in male patients and in patients under 65 years old at first treatment. Overall, the cumulative incidence of secondary cancer at 12 years was 10.5%, after correction in a competing-risk model. Univariate and multivariate Cox regression analyses showed that older age at the time of diagnosis, male sex, and fludarabine-containing therapy had significant negative impacts on the time free of second tumors. Conclusions: We have identified subgroups of non-Hodgkin’s lymphoma patients with increased standardized incidence ratios of secondary malignancy and variables that have a negative impact on the time free of second tumors. This information could help physicians to select the most appropriate treatments. Finally, taking into account the possible occurrence of secondary neoplasia, long-term monitoring must be considered. Key words: second cancer, non-Hodgkin lymphoma, follicular lymphoma, small lymphocytic lymphoma, treatment. Related Articles Comment to: Secondary malignancies after treatment for indolent non-Hodgkin’s lymphoma: a 16-year follow-up study. Haematologica 2008; 93:398-403 Ellen van der Spek, René van der Griend Haematologica 2008 93: e57. Full Text PDF Reply to: Comment to: Secondary malignancies after treatment for indolent non-Hodgkin’s lymphoma: a 16-year follow-up study. Haematologica 2008; 93:398-403 S. Sacchi Haematologica 2008 93: e58. Full Text PDF Secondary malignancies after therapy of indolent non-Hodgkin’s lymphoma Jonathan W. Friedberg Haematologica 2008 93: 336-338. Full Text PDF