Tohoku J. Exp. Med., 2021 June, 254(2)

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.

Key words —— cancer registry; composite lymphoma; discordant lymphoma; epidemiology; sequential lymphoma


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.


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.