Risk for second nonlymphoid neoplasms in chronic lymphocytic leukemia

Major advances have occurred in understanding the biology, immunology, and modalities of treatment of chronic lymphocytic leukemia (CLL) in the last decade. B-cell CLL is the most common type of leukemia occurring in the US and Western nations. B-cell CLL is characterized by progressive defects in both cell-mediated and humoral-mediated immunity. B-lymphocyte defects, low gammaglobulin levels, and quantitative and functional T-cell defects have been documented in the setting of CLL. In concert with each other, they account for the increased susceptibility of the CLL patients to infectious agents. Moreover, several recent surveys have pointed out that CLL patients are at high risk of developing a large variety of second malignant neoplasms. Different therapeutic modalities used for CLL may further exacerbate immunosuppression by depleting both T- and B-immune effectors, thus favoring various infectious diseases and perhaps altering the immune surveillance. The occurrence of 2 or more second cancers is increasingly reported in the context of CLL. Increased awareness of this association is warranted. Future development of surveillance strategies may be needed for a growing population of surviving patients who are at risk for second nonlymphoid neoplasms.