Malignant (Diffuse) Mesothelioma in Patients With Hematologic Malignancies: A Clinicopathologic Study of 45 Cases

Our plain-English summary of Malignant (Diffuse) Mesothelioma in Patients With Hematologic Malignancies: A Clinicopathologic Study of 45 Cases, by X. Li, N.A. Brownlee, T.A. Sporn, et al (Archives of Pathology & Laboratory Medicine, 2015).

The study

• Authors: X. Li, N.A. Brownlee, T.A. Sporn, A. Mahar, V.L. Roggli
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2015;139(9):1129-36
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: Ionizing radiation has a role in the development of malignant mesothelioma, in several epidemiologic studies, including patients with hematologic malignancies.

Objective: To study the clinicopathologic characteristics of patients with malignant mesothelioma and hematologic malignancies with and without a history of radiotherapy.

Design: From a database of approximately 3600 patients with malignant mesothelioma, we identified 45 patients (1%) who also had hematologic malignancies. We examined clinicopathologic features and noted whether the patient had received radiotherapy for malignancy, comparing those with and those without such exposure.

Results: Among the 45 cases, 18 (40%) had Hodgkin lymphoma, 15 (33%) had non-Hodgkin lymphoma, 10 (4%) had chronic lymphocytic leukemia, and 2 (22%) had chronic myelogenous leukemia; 20 patients (44%) had a history of radiotherapy, and 23 (51%) did not. Most patients with Hodgkin lymphoma (16 of 18; 90.0%) received radiation, whereas none of the patients with leukemia (0 of 12) and only 20% (3 of 15) of the patients with non-Hodgkin lymphoma did so. Patients without radiation were older than patients who received radiotherapy (median, 73 versus 54 years, respectively; P < .001), had a shorter interval from diagnosis of hematologic malignancy to that of mesothelioma (median, 2 versus 24 years, respectively; P < .001), and had a shorter survival period (median, 6.0 versus 14.0 months, respectively; P = .02). Epithelial mesotheliomas were proportionately more common in patients with a history of radiotherapy.

Conclusions: Patients with mesothelioma and hematologic malignancies with a history of radiation tended to be younger, had a longer interval from diagnosis of hematologic malignancy to that of mesothelioma, had a longer survival period, and were more likely to have the epithelial variant compared with patients without radiotherapy.

In plain English

The authors looked back at 45 patients who had both malignant mesothelioma and a blood cancer. The patients were found among more than 3600 mesothelioma cases, mainly professional and medicolegal consultations from 1982 to 2013. Eighteen had Hodgkin lymphoma, 15 non-Hodgkin lymphoma and 12 leukemia. Of 39 patients with occupational information, the largest groups were household contacts of asbestos workers and boiler or power plant workers (9 each). The authors compared 19 patients who had radiation treatment 9 or more years before mesothelioma with 23 who never had radiation. The radiated group was younger at mesothelioma diagnosis (median 54 versus 73 years) and had a longer gap between the two cancers (median 24 versus 2 years). It more often had the epithelial type (15 of 19) and survived longer (median 14.0 versus 6.0 months). Among epithelial cases alone, the survival difference was not statistically significant. The authors suggested many co-occurrences, particularly with chronic lymphocytic leukemia, may have been chance. They noted missing data on radiation dose and asbestos exposure intensity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective clinicopathologic case series drawn from a mesothelioma consultation database, with comparison of patients with and without prior radiation therapy
• Who was studied: 45 patients with both malignant mesothelioma and a hematologic malignancy (37 men, 8 women). They were identified among more than 3600 consecutive mesothelioma cases, mainly professional and medicolegal consultation cases, from 1982 to 2013.
• Exposure: Radiation therapy for an earlier cancer (mostly Hodgkin lymphoma), compared with no radiation. Asbestos exposure histories were recorded from occupations: occupational information was available for 39 of 45. The largest categories were household contact of an asbestos worker and boiler or power plant worker. No intensity data were available.
• Main results:
  • Among all 45 patients, 12 (27%) had leukemia, 15 (33%) had non-Hodgkin lymphoma and 18 (40%) had Hodgkin lymphoma.
  • Among all 45 patients, 42 mesotheliomas (93%) arose in the pleura and 3 (7%) in the peritoneum.
  • 16 of 18 Hodgkin lymphoma patients (89.0%) had radiation 9 or more years before mesothelioma. No leukemia patients and 3 of 15 non-Hodgkin lymphoma patients had radiotherapy.
  • Median age: 73 years in the 23 patients without radiation versus 54 years in the 19 radiated patients (P less than .001).
  • Median interval from diagnosis of the blood cancer to mesothelioma: 2 years in the non-radiated group versus 24 years in the radiated group (P less than .001).
  • Mesothelioma type: 15 of 19 radiated patients (79.0%) had epithelial mesothelioma. In the 23 non-radiated patients, 9 had sarcomatoid, 9 epithelial and 5 biphasic.
  • Median survival after mesothelioma diagnosis was 14.0 months in radiated patients versus 6.0 months in non-radiated patients (P = .02).
  • Among patients with epithelial mesothelioma only, median survival was 18.0 versus 9.0 months, not statistically significant (P = .24).
  • Mean duration of asbestos exposure was 23.9 years in radiated patients versus 25.8 years in non-radiated patients (P = .76).
  • Among all 45 patients, parietal pleural plaques were found in 13 (29%) and absent in 9 (20%). In one radiated patient (case 23), lung fiber analysis showed an elevated level of amosite fibers.
  • The authors suggested that for many cases, especially chronic lymphocytic leukemia in elderly patients, the co-occurrence may have been chance.
• The authors' conclusion: The authors concluded that patients with mesothelioma and prior radiation for a blood cancer differed from those without radiation. The radiated patients were younger at diagnosis of both cancers, had a longer interval between the cancers and survived longer. Their blood cancer was more often Hodgkin disease, and their mesothelioma more often epithelial.
• Limitations the authors state:
  • No information on radiation dose or intensity of asbestos exposure
  • Information on asbestosis or pleural plaques was missing for many cases
  • The small number of cases may explain why the survival difference among epithelial cases was not significant

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma.

Related studies

• Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma — L.R. Chirieac, J.A. Barletta, et al. (2013)
• Diffuse malignant mesothelioma and synchronous lung cancer: A clinicopathological study of 18 cases — K.J. Butnor, N.A. Brownlee, et al. (2016)
• Clinicopathologic and genetic characteristics of young patients with pleural diffuse malignant mesothelioma — M. Vivero, R. Bueno, et al. (2018)
• Asbestos exposure and haematological malignancies: a Danish cohort study — E.T. Würtz, J. Hansen, et al. (2020)
• Multiple primary malignancies — R.S. Hoffman, A.H. Rossof, et al. (1984)
• Newly discovered quick, non-invasive screening method of bone marrow malignancies including various leukemias, Hodgkin's lymphoma, non-Hodgkin's lymphoma, & multiple myeloma by abnormality of small rectangular area within bone marrow organ representation areas of the face — Y. Omura, B. O'Young, et al. (2012)

Browse more research in Archives of Pathology & Laboratory Medicine, or return to medical research.