[Clinical Features and Prognosis of Patients with Hematologic Malignancies and Second Primary Cancer]

To explore the clinical characteristics and prognosis of second primary cancers (SPC) in patients with hematologic malignancies. Additionally, it aims to characterize hematologic malignancies that develop as SPC following prior solid tumors.

A retrospective analysis was conducted on the clinical data of patients with hematologic malignancies treated at Wuxi People's Hospital affiliated to Nanjing Medical University from January 2018 to December 2024. Patients with hematological tumors combined with other tumors were screened, and their clinical characteristics and prognosis were evaluated.

A total of 236 patients with hematologic malignancies were included in this study. Among them, 116 cases were complicated with SPC, including 26 cases with hematologic malignancies as the first primary cancer(FPC), which were classified as the FPC group of hematological tumors; and 90 cases diagnosed with hematological tumors after suffering from other malignant tumors in the past, which were classified as the SPC group of hematological tumors. The remaining 120 patients had only hematologic malignancies without other cancers (the single hematologic system tumor group). The rate of prior exposure to chemotherapy and/or radiotherapy for the FPC was significantly higher in the hematologic FPC group compared to the solid SPC group (80.8% vs. 34.4%, P < 0.001). Multivariable logistic regression analysis demonstrated that concomitant chronic diseases (OR =1.803, 95%CI :1.035-3.141, P =0.037) and increasing age at diagnosis of hematologic malignancies (OR =1.033, 95%CI :1.009-1.057, P =0.006) were identified as independent risk factors for SPC development. The median OS in the hematologic system tumor with SPC group was lower than that in the single hematologic system tumor group (32 months vs. 49 months), with a statistically significant difference (P < 0.05). Cox proportional hazards model analysis showed that a diagnostic interval of less than 60 months between the two cancers independently predicted inferior overall survival (HR=2.099, 95%CI :1.207-3.650, P =0.009).

The development of SPC in patients with hematologic malignancies is closely associated with advanced age, chronic comorbidities, and prior exposure to chemotherapy and/or radiotherapy. Patients with both hematologic malignancies and SPC have significantly worse overall survival than those with hematologic malignancies alone. A diagnostic interval of less than 60 months between the two cancers is an independent adverse prognostic factor and may serve as a simple prognostic indicator. Therefore, intensified surveillance and long-term follow-up are warranted for high-risk patients.