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Prior history of non-melanoma skin cancer is associated with increased mortality in patients with chronic lymphocytic leukemia

¹ National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
² Howard Hughes Medical Institute, Chevy Chase, MD, USA
³ Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
⁴ Information Management Services, Inc., Rockville, MD, USA

Correspondence: Jorge R. Toro, Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Bldg. EPS/Room 7012, Bethesda, MD 20892-7236, USA.E-mail:toroj{at}mail.nih.gov

We investigated whether a previous diagnosis of non-melanoma skin cancer among chronic lymphocytic leukemia patients is a predictor of poor outcome. Using the Swedish Cancer Registry, we conducted a population-based study to evaluate the survival patterns among chronic lymphocytic leukemia patients with and without non-melanoma skin cancer. Cox proportional hazards regression models were used and Kaplan-Meier curves were constructed. Of a total of 12,041 chronic lymphocytic leukemia cases identified, 236 cases, including 111 squamous cell cancer, had a prior history of non-melanoma skin cancer. Chronic lymphocytic leukemia patients with a prior history of non-melanoma skin cancer had a 1.29-fold (95% CI 1.10–1.52; p=0.0024) increased risk of dying; and those with a history of squamous cell cancer had a further elevated 1.86-fold (95% CI 1.46–2.36; p<0.0001) risk of dying. Kaplan-Meier plots showed that patients with a history of non-melanoma skin cancer, particularly those with squamous cell cancer, had significantly poorer survival than chronic lymphocytic leukemia patients without non-melanoma skin cancer (p<0.0001; log-rank test). Non-melanoma skin cancer may be a novel clinical predictor of worse chronic lymphocytic leukemia outcome.

Key words: chronic lymphocytic leukemia, non-melanoma skin cancer, squamous cell carcinoma, susceptibility, pathogenesis, immune disruption, immunosuppression, survival, prognosis.