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Increased incidence of myelodysplastic syndrome and acute myeloid leukemia following breast cancer treatment with radiation alone or combined with chemotherapy: a registry cohort analysis 1990-2005.

Kaplan HG, Malmgren JA, Atwood MK - BMC Cancer (2011)

Bottom Line: Rates observed at our community based cancer care institution were compared to SEER incidence data for rate ratio (RR) calculations. 17 cases of MDS/AML (10 MDS/7 AML) occurred during the follow up period, crude rate .29% (95% CI = .17, .47), SEER comparison RR = 3.94 (95% CI = 2.34, 6.15).The RR of MDS in patients age < 65 comparing our cohort incidence to SEER incidence data was 10.88 (95% CI = 3.84, 24.03) and the RR of AML in patients age < 65 was 5.32 (95% CI = 1.31, 14.04).Although a small number of patients are affected, leukemia risk associated with treatment and younger age is significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Swedish Cancer Institute at Swedish Medical Center, Seattle, WA, USA. kaplan.hank@swedish.org

ABSTRACT

Background: Our objective was to measure myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML) risk associated with radiation and/or chemotherapy breast cancer (BC) treatment.

Methods: Our study cohort was composed of BC patients diagnosed from 1990 to 2005 and followed up for blood disorders, mean length of follow up = 7.17 years, range 2-18 years. 5790 TNM stage 0-III patients treated with surgery alone, radiation and/or chemotherapy were included. Patients without surgery (n = 111), with stem cell transplantation (n = 98), unknown or non-standard chemotherapy regimens (n = 94), lost to follow up (n = 66) or 'cancer status unknown' (n = 67) were excluded. Rates observed at our community based cancer care institution were compared to SEER incidence data for rate ratio (RR) calculations.

Results: 17 cases of MDS/AML (10 MDS/7 AML) occurred during the follow up period, crude rate .29% (95% CI = .17, .47), SEER comparison RR = 3.94 (95% CI = 2.34, 6.15). The RR of MDS in patients age < 65 comparing our cohort incidence to SEER incidence data was 10.88 (95% CI = 3.84, 24.03) and the RR of AML in patients age < 65 was 5.32 (95% CI = 1.31, 14.04). No significant increased risk of MDS or AML was observed in women ≥ 65 or the surgery/chemotherapy-only group. A RR of 3.32 (95% CI = 1.42, 6.45) was observed in the surgery/radiation-only group and a RR of 6.32 (95% CI = 3.03, 11.45) in the surgery/radiation/chemotherapy group. 3 out of 10 MDS cases died of disease at an average 3.8 months post diagnosis and five of seven AML cases died at an average 9 months post diagnosis.

Conclusions: An elevated rate of MDS and AML was observed among breast cancer patients < 65, those treated with radiation and those treated with radiation and chemotherapy compared to available population incidence data. Although a small number of patients are affected, leukemia risk associated with treatment and younger age is significant.

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15 year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia (n = 17).
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Figure 2: 15 year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia (n = 17).

Mentions: We calculated crude incidence rates of MDS/AML and all leukemia types (MDS, AML, CML, CLL, ALL) for two and five year minimum follow up by treatment combinations (tables 3 and 4). Crude rate of MDS/AML incidence was .29% (95% CI = .17, .47). By treatment category with minimum 2 years follow up the crude rates were .25 (7/2764) surgery/radiation (95% CI = .10, .52), .16 (1/639) surgery/chemotherapy (95% CI = .00, .87) and .46 (9/1959) surgery/radiation/chemotherapy (95% CI = .21, .87). No difference in MDS/AML was observed in the anthracycline compared to the non-anthracycline adjuvant chemotherapy treatment group. Crude all leukemia incidence rate (MDS, AML, CML, CLL, ALL) was .45% for two year minimum follow up. Crude rates of MDS/AML or combined all leukemia did not differ significantly by treatment regimen. Using Kaplan-Meier one-minus-survival curve estimates, the 5-year MDS/AML cumulative incidence rate was .20%, the 10-year rate was .50% and the 15-year rate was .70% (Figure 2).


Increased incidence of myelodysplastic syndrome and acute myeloid leukemia following breast cancer treatment with radiation alone or combined with chemotherapy: a registry cohort analysis 1990-2005.

Kaplan HG, Malmgren JA, Atwood MK - BMC Cancer (2011)

15 year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia (n = 17).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141775&req=5

Figure 2: 15 year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia (n = 17).
Mentions: We calculated crude incidence rates of MDS/AML and all leukemia types (MDS, AML, CML, CLL, ALL) for two and five year minimum follow up by treatment combinations (tables 3 and 4). Crude rate of MDS/AML incidence was .29% (95% CI = .17, .47). By treatment category with minimum 2 years follow up the crude rates were .25 (7/2764) surgery/radiation (95% CI = .10, .52), .16 (1/639) surgery/chemotherapy (95% CI = .00, .87) and .46 (9/1959) surgery/radiation/chemotherapy (95% CI = .21, .87). No difference in MDS/AML was observed in the anthracycline compared to the non-anthracycline adjuvant chemotherapy treatment group. Crude all leukemia incidence rate (MDS, AML, CML, CLL, ALL) was .45% for two year minimum follow up. Crude rates of MDS/AML or combined all leukemia did not differ significantly by treatment regimen. Using Kaplan-Meier one-minus-survival curve estimates, the 5-year MDS/AML cumulative incidence rate was .20%, the 10-year rate was .50% and the 15-year rate was .70% (Figure 2).

Bottom Line: Rates observed at our community based cancer care institution were compared to SEER incidence data for rate ratio (RR) calculations. 17 cases of MDS/AML (10 MDS/7 AML) occurred during the follow up period, crude rate .29% (95% CI = .17, .47), SEER comparison RR = 3.94 (95% CI = 2.34, 6.15).The RR of MDS in patients age < 65 comparing our cohort incidence to SEER incidence data was 10.88 (95% CI = 3.84, 24.03) and the RR of AML in patients age < 65 was 5.32 (95% CI = 1.31, 14.04).Although a small number of patients are affected, leukemia risk associated with treatment and younger age is significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Swedish Cancer Institute at Swedish Medical Center, Seattle, WA, USA. kaplan.hank@swedish.org

ABSTRACT

Background: Our objective was to measure myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML) risk associated with radiation and/or chemotherapy breast cancer (BC) treatment.

Methods: Our study cohort was composed of BC patients diagnosed from 1990 to 2005 and followed up for blood disorders, mean length of follow up = 7.17 years, range 2-18 years. 5790 TNM stage 0-III patients treated with surgery alone, radiation and/or chemotherapy were included. Patients without surgery (n = 111), with stem cell transplantation (n = 98), unknown or non-standard chemotherapy regimens (n = 94), lost to follow up (n = 66) or 'cancer status unknown' (n = 67) were excluded. Rates observed at our community based cancer care institution were compared to SEER incidence data for rate ratio (RR) calculations.

Results: 17 cases of MDS/AML (10 MDS/7 AML) occurred during the follow up period, crude rate .29% (95% CI = .17, .47), SEER comparison RR = 3.94 (95% CI = 2.34, 6.15). The RR of MDS in patients age < 65 comparing our cohort incidence to SEER incidence data was 10.88 (95% CI = 3.84, 24.03) and the RR of AML in patients age < 65 was 5.32 (95% CI = 1.31, 14.04). No significant increased risk of MDS or AML was observed in women ≥ 65 or the surgery/chemotherapy-only group. A RR of 3.32 (95% CI = 1.42, 6.45) was observed in the surgery/radiation-only group and a RR of 6.32 (95% CI = 3.03, 11.45) in the surgery/radiation/chemotherapy group. 3 out of 10 MDS cases died of disease at an average 3.8 months post diagnosis and five of seven AML cases died at an average 9 months post diagnosis.

Conclusions: An elevated rate of MDS and AML was observed among breast cancer patients < 65, those treated with radiation and those treated with radiation and chemotherapy compared to available population incidence data. Although a small number of patients are affected, leukemia risk associated with treatment and younger age is significant.

Show MeSH
Related in: MedlinePlus