Reply to: [Comment to: Secondary malignancies after treatment for indolent non-Hodgkin’s lymphoma: a 16-year follow-up study. Haematologica 2008; 93:398-403

Although incurable, better treatments have improved life expectancy in non Hodgkin lymphoma patients. In our series, with a median age of 60 years, the 5 years overall survival rate is 75% (CI95% 71–78%). Then, the risk of secondary cancers and other late sequelae is becoming an important concern, as happened in the past for Hodgkin lymphoma patients. Thus, we think that knowing factors related to late side effects could help physicians to manage these patients. The “16 years follow up” of the title refers to the length of our study that ranges between 1988 and 2003. The median follow up, reported in the paragraph of Results, is 62 months for all patients, and 70 months for alive patients. We apologize for the incorrect AER reported in Table 4, that is + 1.22 instead of + 1.01. However, the SIR between female and male gender was statistically different, as reported in Table 4 and in the section Results. Further, male gender was utilized in the Cox regression model (Table 6), as a risk factor. We deeply analyzed the possible reasons for the higher incidence in the male gender, without finding any clear explanation. We observed an excess of second cancer mainly in the period 1988–1994, but no relation with chemotherapy or radiotherapy was observed. We can just speculate on a synergistic effect of pollution in factories and smoking habit, more common in male at this time, and treatments but no data from the database can support this hypothesis. Regarding aggressive lymphoma, we did not find differences between gender (data in press), although other reports showed an excess of second cancer in male gender1 or did not evaluate SIR by sex.2