Characteristics and Outcomes of Lymphoid Malignancies in Female United States Military Veterans

Introduction: Historically, women have comprised a small proportion of the veteran population. Consequently, there is a lack of data on features of malignancies in female veterans. In recent years, an increasing number of women are enlisting in the military, underscoring the importance of defining the development and behavior of malignancies in female veterans. Here we analyze the population of female veterans diagnosed with lymphoid malignancies whose data were available from the comprehensive and longitudinal national VA medical records.

Methods: Female patients diagnosed with lymphoid malignancies were identified from the national VA medical record system. Subjects with sufficient clinical data including diagnosis, date of diagnosis, age of diagnosis, exposure to toxins, treatments, date of last follow up, date of death, cause of death were included in the study. Descriptive statistics were used to summarize patient characteristics. Overall survival was calculated from time of diagnosis to death from any cause and plotted on a Kaplan-Meier curve using SAS.

Results: Out of 73,723 veterans diagnosed with lymphoid malignancies between 1945 and 2022, 1834 (2.5%) were female veterans with sufficient data for analysis. These patients were mostly White (71%) or Black (26%). Almost 60% of patients reported previous or current tobacco use. Despite almost half (48%) of the patients having served in the army, few patients reported military exposures such as Agent Orange (AO) (1%), ionizing radiation (0.05%), or Southwest Asia related conditions. The median age at diagnosis was 60 years (range, 19-98) with a median latency from enlistment to diagnosis of 38 years (range, 0.1-77). Half of the patients were diagnosed with stage 3 or 4 disease but almost 90% of patients had an excellent performance status (ECOG 0-1). Fifty-five percent of patients received systemic therapy. The most frequent subtypes were indolent lymphomas (23%), multiple myeloma (20%), CLL/SLL (17%), and aggressive B-cell lymphomas (15%). The respective median overall survival of these 4 subtypes was 11.4 years (95% CI 10.1-12.8), 4.9 years (95% CI 4.1-5.7), 9.6 years (95% CI 8.6-11.1), and 7.6 years (95% CI 5-10). Of the 679 patients who died, over half (54%) died from malignant neoplasms of lymphoid, hematopoietic and related tissue.

Conclusion: Given the low frequency of military exposures, the vast majority of lymphoid malignancies that developed in female veterans were not likely to be related to AO, ionizing radiation, or Southwest Asia exposures. In this cohort, indolent lymphomas and myeloma were most common. Although half of patients were diagnosed at advanced stages, most had excellent performance status, potentially making them candidates for aggressive therapies as needed. We hope these data will help inform the evaluation and management of female veterans in the future.

No relevant conflicts of interest to declare.