Hairy cell leukemia patients are at increased risk for second malignancies, including both solid and lymphoid neoplasms. Along with other factors, multiple immune defects present in hairy cell leukemia likely contribute to subsequent carcinogenesis. We report herein a case of synchronous high-grade gastric and ampullary adenocarcinomas in a patient with a history of hairy cell leukemia treated eight years prior with pentostatin. We include a review of immune alterations induced by both hairy cell leukemia and its therapies, and link them with the occurrence of second cancers in these patients.
DasanuCAIchimTEAlexandrescuDT. Inherent and iatrogenic immune defects in hairy cell leukemia: revisited. Expert Opin Drug Saf2010; 9: 55–64.
2.
CornetETomowiakCTanguy-SchmidtA. Long-term follow-up and second malignancies in 487 patients with hairy cell leukaemia. Br J Haematol2014; 166: 390–400.
3.
DasanuCA. Intrinsic and treatment-related immune alterations in chronic lymphocytic leukaemia and their impact for clinical practice. Expert Opin Pharmacother2008; 9: 1481–1494.
4.
DasanuCAAlexandrescuDT. Risk of additional cancers in untreated and treated hairy cell leukemia patients. Expert Opin Pharmacother2010; 11: 41–50.
5.
BurtonJKayNE. Does IL-2 receptor expression and secretion in chronic B-cell leukemia have a role in down-regulation of the immune system. Leukemia1994; 8: 92–96.
6.
MossPAGillespieG. Clonal populations of T-cells in patients with B-cell malignancies. Leuk Lymphoma1997; 27: 231–238.
7.
XieXYSorbaraLKreitmanRJ. Development of lymphoproliferative disorder of granular lymphocytes in association with hairy cell leukemia. Leuk Lymphoma2000; 37: 97–104.
8.
Kluin-NelemansHCKesterMGvan deCorputL. Correction of abnormal T-cell receptor repertoire during interferon-alpha therapy in patients with hairy cell leukemia. Blood1998; 91: 4224–4231.
9.
BigdaJMysliwskaJBaranW. Interleukin 2- and interferon alpha induced natural killer cell activity as a marker of progression in hairy cell leukemia. Leuk Lymphoma1993; 9: 371–376.
10.
LauriaFRondelliDRaspadoriD. Rapid restoration of natural killer activity following treatment with 2-chlorodeoxyadenosine in 22 patients with hairy-cell leukemia. Eur J Haematol1994; 52: 16–20.
11.
NeteaMGHoitinkOKullbergBJ. Defective interferon-gamma production in patients with hairy cell leukaemia. Neth J Med2008; 66: 340–343.
12.
Bourguin-PlonquetARouardHRoudot-ThoravalF. Severe decrease in peripheral blood dendritic cells in hairy cell leukaemia. Br J Haematol2002; 116: 595–597.
13.
SeymourJFKurzrockRFreireichEJ. 2-Chlorodeoxyadenosine induces durable remissions and prolonged suppression of CD4+ lymphocyte counts in patients with hairy cell leukemia. Blood1994; 83: 2906–2911.
14.
BastieJNCazals-HatemDDanielMT. Five years follow-up after 2-chlorodeoxyadenosine treatment in thirty patients with hairy cell leukemia: evaluation of minimal residual disease and CD4+ lymphocytopenia after treatment. Leuk Lymphoma1999; 35: 555–565.
15.
KrautEHNeffJCBouroncleBA. Immunosuppressive effects of pentostatin. J Clin Oncol1990; 8: 848–855.
16.
HoADMännelDNWulfG. Long-term effects of 2’-deoxycoformycin treatment on cytoline production in patients with hairy cell leukemia. Leukemia1990; 4: 584–589.
17.
Van der KolkLEBaarsJWPrinsMH. Rituximab treatment results in impaired secondary humoral immune responsiveness. Blood2002; 100: 2257–2259.
18.
Gonzalez-StawinskiGVYuPBLoveSD. Hapten-induced primary and memory humoral responses are inhibited by the infusion of anti-CD20 monoclonal antibody (IDEC-C2B8, rituximab). Clin Immunol2001; 98: 175–179.
19.
JacobsRHVokesEEGolombHM. Second malignancies in hairy cell leukemia. Cancer1985; 56: 1462–1467.
20.
Perunicic-JovanovicMDjunicITominD. Simultaneous presentation of hairy cell leukemia and metastatic signet ring carcinoma of the stomach diagnosed by bone marrow biopsy. Appl Immunohistochem Mol Morphol2001; 19: 279–282.
21.
KurzrockRStromSSEsteyE. Second cancer risk in hairy cell leukemia: analysis of 350 patients. J Clin Oncol1997; 15: 1803–1810.
22.
AuWYKlasaRJGallagherR. Second malignancies in patients with hairy cell leukemia in British Columbia: a 20-year experience. Blood1998; 92: 1160–1164.
23.
FedericoMZinzaniPLFrassoldatiA. Risk of second cancer in patients with hairy cell leukemia: long-term follow-up. J Clin Oncol2002; 20: 638–646.
24.
PaltielOAdlerBBarchanaM. A population-based study of hairy cell leukemia in Israel. Eur J Haemetol2006; 77: 372–377.
25.
HisadaMChenBEJaffeES. Second cancer incidence and cause-specific mortality among 3104 patients with hairy cell leukemia: a population-based study. J Nat Cancer Inst2007; 99: 215–222.
26.
KampmeierPSpielbergerRDicksteinJ. Increased incidence of second neoplasms in patients treated with interferon alpha 2b for hairy cell leukemia: a clinicopathologic assessment. Blood1994; 83: 2931–2938.
27.
NielsenBBraideIHasselbalchH. Evidence for an association between hairy cell leukemia and renal cell and colorectal carcinoma. Cancer1992; 70: 2087–2090.
28.
SavenABurianCKoziolJA. Long-term follow-up of patients with hairy cell leukemia after cladribine treatment. Blood1998; 92: 1918–1926.
29.
RosenbergJDBurianCWaalenJ. Clinical characteristics and long-term outcome of young hairy cell leukemia patients treated with cladribine: a single-institution series. Blood2014; 123: 177–183.
30.
Senatore FJ, Ynson ML and Dasanu CA. Adenocarcinoma of the ampulla of Vater: what treatment options are available? J Oncol Pharm Pract 2014; ii: 1078155214538086. [Epub ahead of print].
