Long-term risk and racial disparities in second primary malignancies among diffuse large B-cell lymphoma survivors: A SEER-based analysis MP-SIR analysis (2000–2022)
Bibliographic record
Abstract
Abstract Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma. With more patients surviving initial therapy, the risk of second primary malignancies (SPMs) is an important survivorship concern. We evaluated overall, site-specific, and racial patterns of SPM risk among DLBCL survivors using a population-based dataset. Methods Using SEER 18 registries (2000–2022), we performed a Multiple Primary–Standardized Incidence Ratio (MP-SIR) analysis. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated overall, by latency (6–11, 12–59, 60–119, ≥120 months), cancer site, and race. All reported SIRs with CIs were considered statistically significant at p < 0.05. Results Among 83,014 survivors contributing over 533,000 person-years, 9,989 SPMs were observed versus 7,588 expected (SIR 1.32; 95% CI: 1.29–1.34). Risk peaked at 6–11 months (SIR 1.44; 95% CI: 1.34–1.54) and persisted across 12–59 months (SIR 1.34), 60–119 months (SIR 1.28), and ≥120 months (SIR 1.30). Hematologic malignancies had the greatest excess: Hodgkin lymphoma (SIR 8.57; 95% CI: 7.25–10.07), acute myeloid leukemia (SIR 6.29; 95% CI: 5.71–6.90), acute monocytic leukemia (SIR 7.07; 95% CI: 4.43–10.7), and chronic myeloid leukemia (SIR 2.21; 95% CI: 1.71–2.81). Among solid tumors, high-risk sites included anus (SIR 2.81; 95% CI: 2.23–3.50), salivary gland (SIR 2.79; 95% CI: 2.14–3.58), thyroid (SIR 2.16; 95% CI: 1.88–2.46), tongue (SIR 1.62; 95% CI: 1.31–1.98), stomach (SIR 1.51; 95% CI: 1.30–1.74), liver (SIR 1.67; 95% CI: 1.46–1.91), esophagus (SIR 1.28; 95% CI: 1.05–1.55), kidney (SIR 1.20; 95% CI: 1.08–1.35), and melanoma of the skin (SIR 1.23; 95% CI: 1.12–1.35). Racial disparities were marked: White (SIR 1.29; 95% CI: 1.27–1.32), Black (SIR 1.37; 95% CI: 1.26–1.48), American Indian/Alaska Native (SIR 1.96; 95% CI: 1.45–2.59), and Asian/Pacific Islander (SIR 1.57; 95% CI: 1.45–1.69). All reported site-specific risks were statistically significant (p < 0.05). Conclusion DLBCL survivors experience a sustained, clinically significant excess risk of SPMs extending beyond a decade, driven by secondary hematologic malignancies and high-risk solid tumors of the gastrointestinal tract, endocrine system, and head and neck. Pronounced racial disparities highlight the urgent need for risk-adapted surveillance and equitable survivorship care strategies. Impact Statement: DLBCL survivors face a persistent and clinically significant excess risk of second primary malignancies beyond 10 years, including high-risk solid tumors and hematologic malignancies. Pronounced racial disparities underscore the urgent need for equitable, risk-adapted survivorship strategies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".