The risk and predictors of second primary malignancies in survivors of angioimmunoblastic T-cell lymphoma: a population-based competing risk analysis.

Survivors of angioimmunoblastic T-cell lymphoma (AITL) face a substantial burden of second primary malignancies (SPMs). Using the SEER database (2000-2022), we identified 2217 AITL patients for analysis. The overall SPM risk was significantly elevated versus the general population (SIR = 1.60), driven predominantly by a marked excess of acute myeloid leukemia (SIR = 22.27). Competing risk analysis estimated the cumulative incidence of SPMs at 4.1, 6.5, and 9.6% by 2, 5, and 10 years, respectively. Multivariable analysis confirmed age 55-74 years as an independent risk factor, whereas advanced Ann Arbor stage (III-IV), diagnosis in the recent era (2011-2022), and an unknown time to treatment were associated with a significantly reduced SPM risk. Interpretations of these predictors are limited by competing mortality, follow-up duration, and limited data granularity. These findings define a high risk of hematological SPMs in AITL survivors and underscore the need for risk-stratified long-term surveillance.