Incidence Patterns of Sequential or Composite Lymphoma: A Population-Based Cancer Registry Study

Incidence Patterns of Sequential or Composite Lymphoma: A Population-Based Cancer Registry Study

Daisuke Niino,^1,2 Luong Thi My Hanh,³ Shiro Miura,³ Masahiro Nakashima³ and Masako Iwanaga¹

¹Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Nagasaki, Japan
²Department of Pathology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
³Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Nagasaki, Japan

The development of multiple histologic types of lymphoma in a single patient has been sporadically reported as sequential or composite lymphoma. However, the incidence pattern of such patients has been rarely evaluated in a large population-based setting. We investigated the incidence of sequential or composite lymphoma based on 11,174 lymphoma records from a population-based cancer registry between 1985-2012 in Nagasaki Prefecture, Japan. We identified 99 lymphoma records were of 49 independent patients other than relapse. The prevalence of the sequential or composite lymphomas in a single patient was 0.44% (95% confidence interval [95% CI], 0.32-0.56%) without sex difference. Among the 49 patients, five (10.2%) were composite/discordant lymphoma. The most frequent “composite lymphoma” was a combination of diffuse large B-cell lymphomas (DLBCL) and adult T-cell leukemia (n = 3). A case of “discordant lymphoma” was a combination of follicular lymphoma on spleen and Waldenström macroglobulinemia on bone marrow. The rest of the patients (n = 44, 89.8% of all composite lymphoma) were “sequential lymphoma” with various combination of lymphoma subtypes on different dates. The major combination of the sequential lymphoma was DLBCL after marginal zone lymphomas (n = 4). In the era of improved survival of lymphoma patients, hematologists should be aware of the development of additional lymphomas.

Keywords —— cancer registry; composite lymphoma; discordant lymphoma; epidemiology; sequential lymphoma

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Tohoku J. Exp. Med 2021, 254, 123-127.

Correspondence: Daisuke Niino, M.D., Ph.D., Department of Pathology, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan.

e-mail: niino522@yahoo.co.jp

Correspondence: Masako Iwanaga, M.D., Ph.D., M.P.H., Department of Clinical Epidemiology, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan.

e-mail: masakoiwng@gmail.com