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Ma J, Wang Y. Myeloid neoplasms post cytotoxic therapy: epidemiology, pathogenesis outcomes, prognostic factors, and treatment options. Ann Med 2024; 56:2329132. [PMID: 38608646 PMCID: PMC11018000 DOI: 10.1080/07853890.2024.2329132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/23/2024] [Indexed: 04/14/2024] Open
Abstract
Myeloid neoplasms post cytotoxic therapy (MN-pCT) are a category includes AML, MDS, and MDS/MPN arising in patients exposed to cytotoxic (DNA-damaging) therapy for an unrelated condition in 2022 version World Health Organization (WHO) classification. With improved survival of patients with tumors, the incidence of MN-pCT after chemotherapy and/or radiation therapy among patients with tumors has gradually risen. However, the outcome of MN-pCT is poorer than that of primary myeloid neoplasms. This review summarizes the current understanding based on existing research, as a foundation for further research on MN-pCT.
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Affiliation(s)
- Jing Ma
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Cancer Hospital Airport Branch, Tianjin, China
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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2
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Rönkkö RM, Nevala AO, Pitkäniemi JM, Wartiovaara-Kautto UM, Malila NK. Subsequent malignant neoplasms after primary hematological malignancy in adult patients. Int J Cancer 2024; 155:1007-1013. [PMID: 38664865 DOI: 10.1002/ijc.34973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 07/16/2024]
Abstract
Patients with primary hematological malignancy (HM) are at an elevated risk of subsequent malignant neoplasms (SMNs), which is a common concern after treatment of primary cancer. We identified 45,533 patients aged ≥20 years and diagnosed with primary HM in Finland from 1992 to 2019 from the Finnish Cancer Registry and estimated standardized incidence ratios (SIR) and excess absolute risks per 1000 person-years (EAR) for SMNs. A total of 6076 SMNs were found (4604 solid and 1472 hematological SMNs). The SIRs were higher for hematological SMNs (SIR 4.9, 95% confidence interval [CI] 4.7-5.2) compared to solid SMNs (SIR 1.5, 95% CI 1.4-1.5). The SIRs for hematological SMNs were highest in the young HM patients aged 20-39 years (SIR 9.2, 95% CI 6.8-12.2 in males and SIR 10.5, 95% CI 7.2-14.7 in females) and decreased by age of first primary HM. However, EARs for hematological SMNs were highest in the older patients, aged 60-79 years at their first primary HM (EAR 5.7/1000 and 4.7/1000 in male and female patients, respectively). In conclusion, the incidence of both hematological and solid SMNs were increased in hematological cancer patients. The relative risk (SIR) was highest among younger HM patients with hematological SMNs. The absolute second cancer burden reflected by high EAR arises from solid malignancies in older patients. Our results accentuate the need for vigilance in the surveillance of HM patients.
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Affiliation(s)
- Rosa M Rönkkö
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
- Department of Internal Medicine, Helsinki University Hospital Physical Medicine and Rehabilitation, Helsinki, Finland
- Department of Hematology, University of Helsinki, Helsinki, Finland
| | - Aapeli O Nevala
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Janne M Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ulla M Wartiovaara-Kautto
- Department of Hematology, University of Helsinki, Helsinki, Finland
- Applied Tumor Genomics Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Nea K Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
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3
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Brandt C, Vo JB, Gierach GL, Cheng I, Torres VN, Lawrence WR, McCullough LE, Veiga LHS, Berrington de González A, Ramin C. Second primary cancer risks according to race and ethnicity among U.S. breast cancer survivors. Int J Cancer 2024; 155:996-1006. [PMID: 38685564 PMCID: PMC11250897 DOI: 10.1002/ijc.34971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
Breast cancer survivors have an increased risk of developing second primary cancers, yet risks by race and ethnicity have not been comprehensively described. We evaluated second primary cancer risks among 717,335 women diagnosed with first primary breast cancer (aged 20-84 years and survived ≥1-year) in the SEER registries using standardized incidence ratios (SIRs; observed/expected). SIRs were estimated by race and ethnicity compared with the racial- and ethnic-matched general population, and further stratified by clinical characteristics of the index breast cancer. Poisson regression was used to test for heterogeneity by race and ethnicity. SIRs for second primary cancer differed by race and ethnicity with the highest risks observed among non-Hispanic/Latina Asian American, Native Hawaiian, or other Pacific Islander (AANHPI), non-Hispanic/Latina Black (Black), and Hispanic/Latina (Latina) survivors and attenuated risk among non-Hispanic/Latina White (White) survivors (SIRAANHPI = 1.49, 95% CI = 1.44-1.54; SIRBlack = 1.41, 95% CI = 1.37-1.45; SIRLatina = 1.45, 95% CI = 1.41-1.49; SIRWhite = 1.09, 95% CI = 1.08-1.10; p-heterogeneity<.001). SIRs were particularly elevated among AANHPI, Black, and Latina survivors diagnosed with an index breast cancer before age 50 (SIRs range = 1.88-2.19) or with estrogen receptor-negative tumors (SIRs range = 1.60-1.94). Heterogeneity by race and ethnicity was observed for 16/27 site-specific second cancers (all p-heterogeneity's < .05) with markedly elevated risks among AANHPI, Black, and Latina survivors for acute myeloid and acute non-lymphocytic leukemia (SIRs range = 2.68-3.15) and cancers of the contralateral breast (SIRs range = 2.60-3.01) and salivary gland (SIRs range = 2.03-3.96). We observed striking racial and ethnic differences in second cancer risk among breast cancer survivors. Additional research is needed to inform targeted approaches for early detection strategies and treatment to reduce these racial and ethnic disparities.
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Affiliation(s)
- Carolyn Brandt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, California, USA
| | - Vanessa N Torres
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
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4
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Locatelli F, Martinelli L, Marchetti P, Caliskan G, Badaloni C, Caranci N, de Hoogh K, Gatti L, Giorgi Rossi P, Guarda L, Ottone M, Panunzi S, Stafoggia M, Silocchi C, Ricci P, Marcon A. Residential exposure to air pollution and incidence of leukaemia in the industrial area of Viadana, Northern Italy. ENVIRONMENTAL RESEARCH 2024; 254:119120. [PMID: 38734295 DOI: 10.1016/j.envres.2024.119120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Exposure to air pollution has been proposed as one of the potential risk factors for leukaemia. Work-related formaldehyde exposure is suspected to cause leukaemia. METHODS We conducted a nested register-based case-control study on leukaemia incidence in the Viadana district, an industrial area for particleboard production in Northern Italy. We recruited 115 cases and 496 controls, frequency-matched by age, between 1999 and 2014. We assigned estimated exposures to particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and formaldehyde at residential addresses, averaged over the susceptibility window 3rd to 10th year prior to the index date. We considered potential confounding by sex, age, nationality, socio-economic status, occupational exposures to benzene and formaldehyde, and prior cancer diagnoses. RESULTS There was no association of exposures to PM10, PM2.5, and NO2 with leukaemia incidence. However, an indication of increased risk emerged for formaldehyde, despite wide statistical uncertainty (OR 1.46, 95%CI 0.65-3.25 per IQR-difference of 1.2 μg/m3). Estimated associations for formaldehyde were higher for acute (OR 2.07, 95%CI 0.70-6.12) and myeloid subtypes (OR 1.79, 95%CI 0.64-5.01), and in the 4-km buffer around the industrial facilities (OR 2.78, 95%CI 0.48-16.13), although they remained uncertain. CONCLUSIONS This was the first study investigating the link between ambient formaldehyde exposure and leukaemia incidence in the general population. The evidence presented suggests an association, although it remains inconclusive, and a potential significance of emissions related to industrial activities in the district. Further research is warranted in larger populations incorporating data on other potential risk factors.
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Affiliation(s)
- Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luigi Martinelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Chiara Badaloni
- Department of Epidemiology, Lazio Region Health Service ASL Roma 1, Rome, Italy
| | - Nicola Caranci
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Luciana Gatti
- Struttura Complessa Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Paolo Giorgi Rossi
- Servizio di Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Emilia-Romagna, Reggio Emilia, Italy
| | - Linda Guarda
- Struttura Complessa Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Marta Ottone
- Servizio di Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Emilia-Romagna, Reggio Emilia, Italy
| | - Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service ASL Roma 1, Rome, Italy
| | - Caterina Silocchi
- Struttura Semplice Salute e Ambiente, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Paolo Ricci
- Former Director UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
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Matsuoka A, Tate S, Nishikimi K, Otsuka S, Usui H, Tajima S, Habu Y, Nakamura N, Okuya R, Katayama E, Shozu M, Inaba Y, Koga K. Therapy-related myeloid neoplasms after treatment for ovarian cancer: A retrospective single-center case series. J Obstet Gynaecol Res 2024; 50:1148-1154. [PMID: 38634254 DOI: 10.1111/jog.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Therapy-related myeloid neoplasms (t-MNs) are often fatal and arise as late complications of previous anticancer drug treatment. No single-center case series has examined t-MNs in epithelial ovarian cancer (EOC). METHODS All patients with EOC treated at Chiba University Hospital between 2000 and 2021 were included. We retrospectively analyzed the characteristics, clinical course, and outcomes of patients who developed t-MNs. RESULTS Among 895 cases with EOC, 814 cases were treated with anticancer drugs. The median follow-up period was 45 months (interquartile range, 27-81) months. Ten patients (1.2%) developed t-MNs (FIGO IIIA in one case, IIIC in three, IVA in one, and IVB in five). Nine patients were diagnosed with myelodysplastic syndrome and one with acute leukemia. One patient with myelodysplastic syndrome developed acute leukemia. The median time from the first chemotherapy administration to t-MN onset was 42 months (range, 21-94 months), with t-MN diagnoses resulting from pancytopenia in four cases, thrombocytopenia in three, and blast or abnormal cell morphology in four. The median number of previous treatment regimens was four (range, 1-7). Paclitaxel + carboplatin therapy was administered to all patients, gemcitabine and irinotecan combination therapy to nine, bevacizumab to eight, and olaparib to four. Six patients received chemotherapy for t-MN. All patients died (eight cancer-related deaths and two t-MN-related deaths). None of the patients was able to restart cancer treatment. The median survival time from t-MN onset was 4 months. CONCLUSIONS Patients with EOC who developed t-MN were unable to restart cancer treatment and had a significantly worse prognosis.
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Affiliation(s)
- Ayumu Matsuoka
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Shinichi Tate
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Kyoko Nishikimi
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Satoyo Otsuka
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Hirokazu Usui
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Shinya Tajima
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Yuji Habu
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Natsuko Nakamura
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Rie Okuya
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Eri Katayama
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Makio Shozu
- Evolution and Reproductive Medicine, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Yosuke Inaba
- Biostatistics Section, Clinical Research Center, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
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Zhang BX, Brantley KD, Rosenberg SM, Kirkner GJ, Collins LC, Ruddy KJ, Tamimi RM, Schapira L, Borges VF, Warner E, Come SE, Winer EP, Bellon JR, Partridge AH. Second primary non-breast cancers in young breast cancer survivors. Breast Cancer Res Treat 2024:10.1007/s10549-024-07400-z. [PMID: 38858235 DOI: 10.1007/s10549-024-07400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE We evaluated the incidence, timing, and risk factors for second primary non-breast cancers (SPNBC) among young breast cancer (BC) survivors. METHODS This study included participants of the Young Women's BC Study (YWS) who were diagnosed with stage 0-III BC between 2006 and 2016 and age 40 or younger at diagnosis (N = 1,230). Patient characteristics, treatment information, and clinical events were collected via serial surveys. Tumor and treatment data were obtained from medical record review. Five- and 10-year risks of SPNBCs were estimated via the cumulative incidence function, considering death, metastasis, or second primary BC as competing events. Fine and Gray subdistribution hazard models estimated subdistribution hazard ratios (sHRs) and 95% confidence intervals (CI) for SPNBC risk based on risk factors including demographics, germline genetics, primary BC characteristics, and treatments. RESULTS Among 1,230 women, over a median follow-up of 10.1 years, 47 patients (4%) developed an SPNBC. Types of malignancy included melanoma (n = 10), thyroid (n = 10), ovarian (n = 4), sarcoma (n = 4), uterine (n = 3), rectal (n = 3), bladder (n = 2), cervical (n = 2), head/neck (n = 2), lung (n = 2), lymphoma (n = 2), pancreatic (n = 2), and renal (n = 1). Five and 10-year cumulative incidence were 1.4% and 3.2%, respectively. Median time between primary BC and SPNBC was 7.3 years. No patient factors, primary tumor characteristics, or treatments were statistically significantly associated with SPNBC in univariable or multivariable models. CONCLUSION In this population, five-year cumulative incidence was higher than that reported among healthy women under 50 years of age, highlighting the importance of long-term surveillance for new non-breast cancers in young adult BC survivors.
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Affiliation(s)
| | - Kristen D Brantley
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | | | - Gregory J Kirkner
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Laura C Collins
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Lidia Schapira
- Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | | | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven E Come
- Harvard Medical School, Boston, MA, USA
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jennifer R Bellon
- Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Ann H Partridge
- Harvard Medical School, Boston, MA, USA.
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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Koivisto HAM, Nevala AO, Miettinen JM, Pitkäniemi JM, Malila NK, Heikkinen SMM. Relative risk of second malignant neoplasms highest among young adult cancer patients - a population-based registry study in Finland. Acta Oncol 2024; 63:418-425. [PMID: 38850051 PMCID: PMC11332513 DOI: 10.2340/1651-226x.2024.34138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/05/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to explore the incidence of second malignant neoplasms (SMNs) among adult cancer patients in Finland diagnosed with their first primary cancer (FPC) in 1992-2021. MATERIAL AND METHODS The study used data from the population-based Finnish Cancer Registry (FCR). Risk estimates were calculated using the standardised incidence ratio (SIR), the ratio of observed second cancers compared to the expected numbers assuming the same cancer incidence as the corresponding sex-age-calendar year -split of the general population. RESULTS A total of 573,379 FPCs were diagnosed during 1992-2021. During the follow-up, 60,464 SMNs were diagnosed. Male cancer patients had neither a decreased nor an increased risk (SIR 1.00 [95% CI, 0.99-1.01]) and female patients had an 8% increased risk (SIR 1.08 [95% CI, 1.06-1.09]) of developing any SMN compared to a FPC in the general population. The highest SIR of any SMN was observed in patients aged 20-39 -years at FPC diagnosis, and the SIR decreased by increasing age at diagnosis. Patients with lymphoid and haematopoietic tissue neoplasms, cancers of the mouth and pharynx, endocrine glands, respiratory and intrathoracic organs, skin, and urinary organs had the highest SIRs, while patients with cancers of the male genital organs and the female breast had the lowest SIRs. INTERPRETATION Elevated SIRs were observed in cancer patients diagnosed at an early age and for FPCs known to be in large part attributable to lifestyle factors, which highlights the importance of monitoring and encouraging lifestyle changes.
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Affiliation(s)
| | - Aapeli O Nevala
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | | | - Janne M Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Nea K Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
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Sedeta E, Jemal A, Nisotel L, Sung H. Survival difference between secondary and de novo acute myeloid leukemia by age, antecedent cancer types, and chemotherapy receipt. Cancer 2024; 130:1952-1963. [PMID: 38244208 DOI: 10.1002/cncr.35214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND This study compared the survival of persons with secondary acute myeloid leukemia (sAML) to those with de novo AML (dnAML) by age at AML diagnosis, chemotherapy receipt, and cancer type preceding sAML diagnosis. METHODS Data from Surveillance, Epidemiology, and End Results 17 Registries were used, which included 47,704 individuals diagnosed with AML between 2001 and 2018. Multivariable Cox proportional hazards regression was used to compare AML-specific survival between sAML and dnAML. Trends in 5-year age-standardized relative survival were examined via the Joinpoint survival model. RESULTS Overall, individuals with sAML had an 8% higher risk of dying from AML (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.05-1.11) compared to those with dnAML. Disparities widened with younger age at diagnosis, particularly in those who received chemotherapy for AML (HR, 1.14; 95% CI, 1.10-1.19). In persons aged 20-64 years and who received chemotherapy, HRs were greatest for those with antecedent myelodysplastic syndrome (HR, 2.04; 95% CI, 1.83-2.28), ovarian cancer (HR, 1.91; 95% CI, 1.19-3.08), head and neck cancer (HR, 1.55; 95% CI, 1.02-2.36), leukemia (HR, 1.45; 95% CI, 1.12-1.89), and non-Hodgkin lymphoma (HR, 1.42; 95% CI, 1.20-1.69). Among those aged ≥65 years and who received chemotherapy, HRs were highest for those with antecedent cervical cancer (HR, 2.42; 95% CI, 1.15-5.10) and myelodysplastic syndrome (HR, 1.28; 95% CI, 1.19-1.38). The 5-year relative survival improved 0.3% per year for sAML slower than 0.86% per year for dnAML. Consequently, the survival gap widened from 7.2% (95% CI, 5.4%-9.0%) during the period 2001-2003 to 14.3% (95% CI, 12.8%-15.8%) during the period 2012-2014. CONCLUSIONS Significant survival disparities exist between sAML and dnAML on the basis of age at diagnosis, chemotherapy receipt, and antecedent cancer, which highlights opportunities to improve outcomes among those diagnosed with sAML.
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MESH Headings
- Humans
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Middle Aged
- Female
- Male
- Adult
- Aged
- SEER Program
- Young Adult
- Age Factors
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/epidemiology
- Aged, 80 and over
- Adolescent
- Proportional Hazards Models
- United States/epidemiology
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/epidemiology
- Neoplasms/mortality
- Neoplasms/drug therapy
- Neoplasms/epidemiology
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Affiliation(s)
- Ephrem Sedeta
- Brookdale University Hospital Medical Center, Brooklyn, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Lauren Nisotel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Travaglini S, Marinoni M, Visconte V, Guarnera L. Therapy-Related Myeloid Neoplasm: Biology and Mechanistic Aspects of Malignant Progression. Biomedicines 2024; 12:1054. [PMID: 38791019 PMCID: PMC11118122 DOI: 10.3390/biomedicines12051054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Therapy-related myeloid neoplasms (t-MN) arise after a documented history of chemo/radiotherapy as treatment for an unrelated condition and account for 10-20% of myelodysplastic syndromes and acute myeloid leukemia. T-MN are characterized by a specific genetic signature, aggressive features and dismal prognosis. The nomenclature and the subsets of these conditions have changed frequently over time, and despite the fact that, in the last classification, they lost their autonomous entity status and became disease qualifiers, the recognition of this feature remains of major importance. Furthermore, in recent years, extensive studies focusing on clonal hematopoiesis and germline variants shed light on the mechanisms of positive pressure underpinning the rise of driver gene mutations in t-MN. In this manuscript, we aim to review the evolution of defining criteria and characteristics of t-MN from a clinical and biological perspective, the advances in mechanistic aspects of malignant progression and the challenges in prevention and management.
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Affiliation(s)
- Serena Travaglini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Massimiliano Marinoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Valeria Visconte
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Luca Guarnera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Vasseur D, Arbab A, Giudici F, Marzac C, Michiels S, Tagliamento M, Bayle A, Smolenschi C, Sakkal M, Aldea M, Sassi H, Dall'Olio FG, Pata-Merci N, Cotteret S, Fiévet A, Auger N, Friboulet L, Facchinetti F, Géraud A, Ponce S, Hollebecque A, Besse B, Micol JB, Italiano A, Lacroix L, Rouleau E. Genomic landscape of liquid biopsy mutations in TP53 and DNA damage genes in cancer patients. NPJ Precis Oncol 2024; 8:51. [PMID: 38409229 PMCID: PMC10897416 DOI: 10.1038/s41698-024-00544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
Next-generation sequencing (NGS) assays based on plasma cell-free DNA (cfDNA) are increasingly used for clinical trials inclusion. Their optimized limit of detection applied to a large number of genes leads to the identification of mutations not confirmed in tissue. It becomes essential to describe the characteristics and consequences of these liquid biopsy-only mutations. In the STING protocol (Gustave Roussy, NCT04932525), 542 patients with advanced solid cancer had cfDNA-based and tissue-based NGS analysis (performed by FoundationOne® Liquid CDx and FoundationOne CDx™, respectively). Mutations identified in the liquid biopsy but not in the paired tissue were considered as liquid biopsy-only mutations irrespective of their variant allelic frequency (VAF). Out of 542 patients, 281 (51.8%) harbored at least one liquid biopsy-only mutation. These patients were significantly older, and more heavily pretreated. Liquid biopsy-only mutations occurring in TP53, and in DDR genes (ATM, CHEK2, ATR, BRCA2, and BRCA1) accounted for 90.8% of all the mutations. The median VAF of these mutations was generally low (0.37% and 0.40% for TP53 and DDR genes respectively). The variant type repartition depended on the gene. Liquid biopsy-only mutations affected hotspot in TP53 codon 273, 125, 195, 176, 237 or 280 and ATM codon 2891 and 3008. In a subset of 37 patients, 75.0%, 53.5% and 83.3% of the liquid biopsy-only mutations occurring respectively in ATM, TP53, and CHEK2 were confirmed in the matching whole blood sample. Although liquid biopsy-only mutations makes the interpretation of liquid biopsy results more complex, they have distinct characteristics making them more easily identifiable.
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Affiliation(s)
- Damien Vasseur
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France.
- AMMICa UAR3655/US23, F-94805, Gustave Roussy, Villejuif, France.
| | - Ahmadreza Arbab
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | - Fabiola Giudici
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France
| | - Christophe Marzac
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France
- Bureau de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Arnaud Bayle
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Cristina Smolenschi
- Cancer Medicine, Gustave Roussy, Villejuif, France
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Madona Sakkal
- Cancer Medicine, Gustave Roussy, Villejuif, France
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | | | - Hela Sassi
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | | | | | - Sophie Cotteret
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | - Alice Fiévet
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | - Nathalie Auger
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
| | - Luc Friboulet
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | - Arthur Géraud
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Santiago Ponce
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | | | - Benjamin Besse
- Cancer Medicine, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | | | - Antoine Italiano
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
- AMMICa UAR3655/US23, F-94805, Gustave Roussy, Villejuif, France
| | - Etienne Rouleau
- Medical Biology and Pathology Department, F-94805, Gustave Roussy, Villejuif, France
- AMMICa UAR3655/US23, F-94805, Gustave Roussy, Villejuif, France
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11
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Kjaer TK, Andersen EAW, Ursin G, Larsen SB, Bidstrup PE, Winther JF, Borre M, Johansen C, Dalton SO. Cumulative incidence of second primary cancers in a large nationwide cohort of Danish cancer survivors: a population-based retrospective cohort study. Lancet Oncol 2024; 25:126-136. [PMID: 38048803 DOI: 10.1016/s1470-2045(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND A new primary cancer is a serious late effect of a pre-existing cancer diagnosis, and can be attributed to hereditary cancer syndromes, immune or hormonal factors, cancer treatment, or modifiable lifestyle or environmental factors. We investigated the absolute and relative incidence of second primary cancers in a large cohort of Danish cancer survivors. Furthermore, we examined the association between alcohol-related, smoking-related, virus-related, and hormone-related first and second primary cancers. METHODS In this retrospective cohort study, we identified a cohort of Danish adults (aged ≥40 years) diagnosed with cancer from Jan 1, 1997, to Dec 31, 2014 and alive 1 year after diagnosis. Follow-up was from date of first cancer diagnosis and lasted up to 24 years, ending on Dec 31, 2020. Cohort identification and information on second primary cancers was obtained from the Danish Cancer Registry, and comorbidity and sociodemographic information was obtained from Danish population-based registries. Overall, and for 27 cancer types, cumulative incidence functions and Cox proportional hazard regression models were used to estimate the incidence of second primary cancer and death, and hazard ratios (HRs) and 95% CIs of second primary cancer adjusted for sex, age and year of diagnosis, cohabitation status, income, and comorbidity. FINDINGS 457 334 Danish adults were included in our study (230 150 [50·3%] male individuals and 227 184 [49·7%] female individuals; median age at diagnosis 68·3 years, IQR 59·7-76·6; median follow-up 3·6 years, IQR 0·6-9·3). The cumulative incidence of second primary cancer increased over time from 6·3% (95% CI 6·2-6·4) 5 years after diagnosis to 10·5% (10·4-10·6) 10 years after diagnosis and to 13·5% (13·4-13·7) 15 years after diagnosis. The highest cumulative incidence of second primary cancer 10 years after diagnosis was observed in survivors of cancers in the larynx (21·8%, 20·5-23·1), oropharynx and oral cavity (19·5%, 18·7-20·3), and bladder and urinary tract (18·5%, 18·0-19·0). Survivors of cancers related to alcohol (HR 1·09, 95% CI 1·06-1·13), smoking (1·73, 1·68-1·78), diet high in red or processed meat (1·32, 1·24-1·39), or virus (1·23, 1·13-1·35) were at increased risk of developing a second cancer with the same aetiology, whereas having had a hormone-related first cancer was associated with lower risk of a second hormone-related cancer (0·77, 0·73-0·81). INTERPRETATION Our results could help optimise prevention efforts targeting modifiable risk factors to reduce risk of developing a second primary cancer. FUNDING Nordic Cancer Union and The Health Foundation (Helsefonden).
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Affiliation(s)
| | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Signe Benzon Larsen
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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12
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Du J, Yuan X. Analysis of the incidence, characteristics, and risk factors of complications during induction chemotherapy in children with high-risk neuroblastoma. Eur J Pediatr 2024; 183:185-202. [PMID: 37855927 DOI: 10.1007/s00431-023-05273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
Patients with high-risk neuroblastoma (HR-NB) exhibit suboptimal 5-year survival rates, leading to a widespread international preference for high-intensity chemotherapeutic regimens in these children. We analyzed the incidence and risk factors for complications during induction chemotherapy in children with HR-NB and tried to assist clinicians in predicting such complications and optimizing therapeutic strategy. The clinical data of children with HR-NB admitted to our hospital from January 2007 to December 2019 were retrospectively analyzed. The incidence, characteristics, and risk factors of complications (infection, hemorrhage, and chemotherapy-related adverse reactions (CRAR)) requiring hospitalization during induction chemotherapy in these children were explored. (1) A total of 108 patients with HR-NB were included in the final analysis. The overall infection rate was 92.6% (100/108), with the highest incidence of 71.3% observed during the first cycle. FN, bacterial infection, as well as fungal infection were common infectious complications in children with HR-NB during induction chemotherapy. (2) The overall hemorrhage rate was 24.1% (26/108), with the highest incidence of 14.8% also observed in the first cycle. Among the children with hemorrhage, there were 72% with bone marrow involved, while 65.0% of them had a high vanillylmandelic acid (VMA) value. And children with hemorrhage also exhibited neuron-specific enolase (NSE) ≥ 200 µg/L in 88.5% of cases and lactic dehydrogenase (LDH) ≥ 1000U/L in 73.1% of cases. (3) The incidence of CRAR rate was 100%, and 99.1% (107/108) patients experienced myelosuppression. The incidence of myelosuppression peaked in the third cycle, reaching up to 85.2%. Most children suffered severe myelosuppression existed with bone marrow metastases (76.3%), abnormal VMA (67.5%), and LDH ≥ 1000 U/L (60%). (4) Non-myelosuppressive adverse effects were observed in 75.9% children (82/108), with the highest incidence occurring in the third cycle at 42.6%. (5) Patients who experienced three types of complications had a lower median survival time (MST) of 54.4 months, a 3-year event-free survival (EFS) rate of (44.2 ± 10.7)%, and a 3-year overall survival (OS) rate of (75.8 ± 8.6)%, in comparison to those with only one or two complications, who had a higher MST of 59.5 months, a 3-year EFS rate of (73.5 ± 5.2)% (X2 = 10.457, P = 0.001), and a 3-year OS rate of (84.8 ± 4.1)% (X2 = 10.511, P = 0.001). CONCLUSION The presence of bone marrow involved and increased VMA were high-risk factors for infection, while NSE ≥ 200 µg/L and LDH ≥ 1000 U/L were high-risk factors for hemorrhage. For those children who had experienced severe myelosuppression, the presence of bone marrow metastases, increased VMA, and LDH ≥ 1000 U/L were their risk factors. The presence of bone involvement was a high-risk factor for children to have non-myelosuppressive adverse effects. Complications that arise during induction chemotherapy could negatively impact the children's prognosis and overall quality of life. WHAT IS KNOWN • The high-risk neuroblastoma (HR-NB) had a worse prognosis; there was a general international preference for high-intensity chemotherapeutic regimens in the induction phase to these children. WHAT IS NEW • We analyzed the incidence and risk factors of complications during induction chemotherapy in children with HR-NB and tried to help clinicians predict such complications and adopt optimized therapeutic strategy.
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Affiliation(s)
- Jiaxi Du
- Department of Pediatric Hematology/Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Yuan
- Department of Pediatric Hematology/Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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13
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Liu KX, Indelicato DJ, Paulino AC, Looi WS, Catalano PJ, Chintagumpala MM, Gallotto SL, Marcus KJ, Haas-Kogan DA, Tarbell NJ, MacDonald SM, Mahajan A, Yock TI. Multi-institutional Characterization of Outcomes for Pediatric and Young Adult Patients With High-Risk Myxopapillary Ependymoma After Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:1174-1180. [PMID: 37437812 DOI: 10.1016/j.ijrobp.2023.06.2293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Myxopapillary ependymoma (MPE) is a rare, typically slow-growing subtype of spinal ependymomas. There are no standard guidelines for radiotherapy and long-term outcomes after radiation, particularly patterns of relapse, for pediatric and young adult (YA) patients with MPE remain under-characterized. METHODS AND MATERIALS This is an Institutional Review Board-approved multi-institutional retrospective cohort study of 60 pediatric and YA patients diagnosed with MPE and received radiotherapy between 2000-2020. Clinical and treatment characteristics, and long-term outcomes were recorded. Site(s) of progression was compared to radiation fields. Survival outcomes were analyzed using Kaplan-Meier method. Cumulative incidence of local in-field progression (CILP) after initial radiotherapy was analyzed using Gray's method with out-of-field-only progression as a competing risk. Univariate analyses were performed using Cox proportional hazard's model. RESULTS The median age at radiation was 14.8 years (range: 7.1-26.5). At time of radiotherapy, 45 (75.0%) and 35 (58.3%) patients had gross residual and multifocal disease, respectively. Forty-eight (80.0%), seven (11.7%) and five (8.3%) patients received involved field radiotherapy, craniospinal irradiation, and whole spine radiation, respectively. Median follow-up from end of radiotherapy was 6.2 years (range: 0.6-21.0). Five-year overall survival, progression-free survival, and CILP were 100%, 60.8% and 4.1%, respectively. Both local recurrences were at sites of gross residual disease. Of the eighteen out-of-field first recurrences after radiotherapy, all were superior to the initial treatment field and nine had intracranial relapse. On univariate analyses, distant-only recurrence before radiation (HR: 4.00, 95% CI: 1.54-10.43, p = 0.005) was significantly associated with shorter time to progression. CONCLUSIONS While the risk of recurrence within the radiation field is low, pediatric and YA patients with high-risk MPE remain at risk for recurrences in the spine above the radiation field and intracranially after radiotherapy. Future prospective studies are needed to investigate the appropriate radiation field and dose based on the extent of metastases.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Wen S Looi
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Murali M Chintagumpala
- Department of Pediatrics, Division of Hematology-Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sara L Gallotto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy J Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Inspire Exercise Medicine, Naples, Florida
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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14
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Zhang Y, Wang YZ, Shi JT, Ma JM, Li B, Zhang WL, Gu HL, Zhou Y, Mei YY, Li S, Liu TT, Jiang LB, Zhao HS, Ge X, Hu HM, Zhi T, Huang DS. Clinical analysis of 2790 children with retinoblastoma: a single-center experience in China. World J Pediatr 2023; 19:1169-1180. [PMID: 37269495 DOI: 10.1007/s12519-023-00719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/14/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In this study, we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma (RB) in a single center in China with a large sample collection spanning 17 years. METHODS The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected, and a retrospective analysis was conducted. RESULTS The median age of the participants was 28.3 months. There were 3624 affected eyes, 12.4% of which were in groups A-C, 67.1% in groups D-E and 16.2% were not specified. The primary symptom observed in most cases was a white pupil, accounting for 66.5%, followed by strabismus (12.8%). The median follow-up time was 59.7 months. The enucleation rate was 71.3% (703/986) in a single left eye and 72.5% (702/968) in a single right eye. The overall survival (OS) rate was 95.8% (2444/2552) because 237 patients dropped out, and 109 died. Kaplan‒Meier survival analysis showed that the median survival time (MST) was 125.92 months [95% confidence interval (CI) = 124.83-127.01]. Cox multivariate survival analysis showed that trilateral RB (P = 0.017), metastasis site (P = 0.001), and combined distant tissue metastasis (P = 0.001) were independent prognostic factors for RB. The OS of 44 cases of familial RB was 93.2% (41/44), with an MST of 80.62 months (95% CI = 67.70-93.54). CONCLUSIONS The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay. More importantly, the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis.
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Affiliation(s)
- Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Yi-Zhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Ji-Tong Shi
- Department of Ophthalmic Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Jian-Min Ma
- Department of Ophthalmic Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Bin Li
- Department of Ophthalmic Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Wei-Ling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Hua-Li Gu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Yan-Yan Mei
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Song Li
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Ting-Ting Liu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Li-Bin Jiang
- Department of Ophthalmic Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Hong-Shu Zhao
- Department of Ophthalmic Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Xin Ge
- Department of Ophthalmic Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Hui-Min Hu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Tian Zhi
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Dong-Sheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
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15
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Renneville A, Bernard E, Micol JB. Therapy-related myelodysplastic syndromes in the genomics era. Bull Cancer 2023; 110:1129-1140. [PMID: 37391357 DOI: 10.1016/j.bulcan.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 07/02/2023]
Abstract
Therapy-related myelodysplastic syndromes (t-MDS) represent a heterogeneous group of malignancies that arise as a late complication of prior exposure to chemotherapy and/or radiotherapy administered for a primary condition. T-MDS account for approximately 20% of all MDS and are characterized by resistance to current treatment strategies and poor prognosis. Our understanding of t-MDS pathogenesis has considerably improved over the last 5 years with the availability of deep sequencing technologies. T-MDS development is now considered as a multifactorial process resulting from complex interactions between an underlying germline genetic susceptibility, the stepwise acquisition of somatic mutations in hematopoietic stem cells, the clonal selection pressure exerted by cytotoxic therapies, and alterations of the bone marrow microenvironment. The survival of patients with t-MDS is generally poor. This can be explained by both patient-related factors including poor performance status and less tolerance to treatment and disease-related factors, such as the presence of chemoresistant clones, high-risk cytogenetic alterations and molecular features (e.g. high frequency of TP53 mutations). Around 50% of t-MDS patients are classified as high/very high risk based on IPSS-R or IPSS-M scores, versus 30% in de novo MDS. Long-term survival is only achieved in a minority of t-MDS patients who receive allogeneic stem cell transplantation, but the development of novel drugs may open new therapeutic opportunities, especially in unfit patients. Further investigations are needed to improve the identification of patients at higher risk of developing t-MDS and determine whether primary disease treatment can be modified to prevent the occurrence of t-MDS.
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Affiliation(s)
- Aline Renneville
- Gustave-Roussy, Department of Medical Biology and Pathology, Villejuif, France; Gustave-Roussy, université Paris-Saclay, Inserm U1287, Villejuif, France
| | - Elsa Bernard
- Gustave Roussy, université Paris-Saclay, Inserm U981, Villejuif, France; Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, USA
| | - Jean-Baptiste Micol
- Gustave-Roussy, université Paris-Saclay, Inserm U1287, Villejuif, France; Gustave-Roussy, université Paris-Saclay, Department of Hematology, Villejuif, France; Gustave-Roussy, université Paris-Saclay, Interception Program, Personalized Cancer Prevention Center, Villejuif, France.
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16
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Araie H, Arai Y, Kida M, Aoki J, Uchida N, Doki N, Fukuda T, Tanaka M, Ozawa Y, Sawa M, Katayama Y, Matsuo Y, Onizuka M, Kanda Y, Kawakita T, Kanda J, Atsuta Y, Yanada M. Poor outcome of allogeneic transplantation for therapy-related acute myeloid leukemia induced by prior chemoradiotherapy. Ann Hematol 2023; 102:2879-2893. [PMID: 37477669 PMCID: PMC10492731 DOI: 10.1007/s00277-023-05356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
Therapy-related acute myeloid leukemia (t-AML) is a therapeutic challenge as a late complication of chemotherapy (CHT) and/or radiotherapy (RT) for primary malignancy. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) presents itself as a curative approach. To establish the optimal allo-HSCT strategy for t-AML, we evaluated the relationship between characteristics of primary malignancy and allo-HSCT outcomes. Patients with t-AML or de novo acute myeloid leukemia (AML) who underwent first allo-HSCT in Japan from 2011 to 2018 were identified using a nationwide database. The detailed background of t-AML was obtained by additional questionnaires. Multivariate analysis and propensity score matching (PSM) analysis were performed to detect the prognostic factors associated with t-AML and compare outcomes with de novo AML. We analyzed 285 t-AML and 6761 de novo AML patients. In patients with t-AML, receiving both CHT and RT for primary malignancy was an independent poor-risk factor for relapse and overall survival (OS) (hazard ratio (HR) 1.62; p = 0.029 and HR 1.65; p = 0.009, reference: CHT alone group), whereas other primary malignancy-related factors had no effect on the outcome. Compared to the CHT alone group, complex karyotypes were significantly increased in the CHT + RT group (86.1% vs. 57.5%, p = 0.007). In the PSM cohort, t-AML patients with prior CHT and RT had significantly worse 3-year OS than those with de novo AML (25.2% and 42.7%; p = 0.009). Our results suggest that prior CHT and RT for primary malignancy may be associated with increased relapse and worse OS of allo-HSCT in t-AML.
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Affiliation(s)
- Hiroaki Araie
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiko Kida
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Jun Aoki
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
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17
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Lee JW, Oh H, You JY, Lee ES, Lee JH, Song SE, Lee NK, Jung SP, An JS, Cho KR, Kim CY, Park KH. Therapy-related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer 2023; 191:112952. [PMID: 37473463 DOI: 10.1016/j.ejca.2023.112952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Long-term complications are becoming more important as the survival rate of breast cancer improves. Treatment-related myeloid neoplasm is an important long-term complication in breast cancer survivors as it has a poor prognosis. OBJECTIVE We evaluated the incidence and risk factors for the development of treatment-related acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) in patients treated with early breast cancer. METHODS We accessed the national Korean database to identify 153,565 patients diagnosed with breast cancer between January 2007 and October 2016 who underwent surgery for breast cancer. We estimated the cumulative incidence of AML/MDS and analysed the risk factors for developing AML/MDS. RESULTS Of 153,575 patients, 79,321 received anthracycline-based adjuvant therapy, 14,317 received adjuvant therapy without anthracyclines and 46,657 did not receive adjuvant chemotherapy. Overall, 120 developed AML (105 in the anthracycline group, 9 in the non-anthracycline group and 6 in the control group), and 128 developed MDS (96, 9 and 23 in each group). The 10-year cumulative incidence of AML/MDS was the highest in the anthracycline group (0.221% and 0.199%), followed by the non-anthracycline group (0.122% and 0.163%) and the control group (0.024% and 0.089%). The risk of developing AML/MDS was significantly higher in patients treated with anthracyclines (hazard ratio [HR] 9.531; p < 0.0001 for AML and HR 2.559; p < 0.0001 for MDS) compared to patients in the control group. CONCLUSION This study found that anthracycline-based adjuvant therapy significantly increased the risk of AML/MDS in Korean breast cancer patients, with the risk persisting for at least 10 years. While the cumulative incidence was low, the long-term risks of AML/MDS should be taken into account considering the poor outcomes associated with these neoplasms.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/complications
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/epidemiology
- Chemotherapy, Adjuvant/adverse effects
- Combined Modality Therapy
- Anthracyclines
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/drug therapy
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
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Affiliation(s)
- Ji Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Hoonji Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Ji Young You
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Eun-Shin Lee
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Hyun Lee
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Nam Kwon Lee
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Seok An
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Cheol Yong Kim
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyong Hwa Park
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea.
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18
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Zhang Q, Ding Y, Shu Y, Chen J. A real-world disproportionality analysis of Rucaparib: Post-marketing Pharmacovigilance Data. BMC Cancer 2023; 23:745. [PMID: 37568126 PMCID: PMC10416473 DOI: 10.1186/s12885-023-11201-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Rucaparib has been approved for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. However, the long-term safety of rucaparib in large sample population was unknown. The presented study aimed to evaluate rucaparib-associated adverse events (AEs) according to the real-world pharmacovigilance database. METHODS Disproportionality analysis was conducted to assess the association between rucaparib and its AEs. Data were collected from the international pharmacovigilance database of US FDA Adverse Event Reporting System (FAERS) between January 2017 and June 2022. The characteristics of rucaparib-related AEs, and the onset time were further analyzed. RESULTS A total of 9,296,694 AE reports were recorded in the FAERS during the study period, among which 7,087 reports were associated with rucaparib. About 135 rucaparib-related AE signals in 15 system organ class (SOCs) were identified. The most common AEs included anaemia, thrombocytopenia, nausea, vomiting, fatigue, blood creatinine increase, alanine aminotransferase increase, and aspartate aminotransferase increase, which were listed in the label for rucaparib. Of note, 21 new and unexpected significant AEs that off-label were also found in our study, such as preferred term (PTs) of intestinal obstruction, gastrooesophageal reflux disease, blood iron decreased, dehydration, and hypersomnia. The median onset time of rucaparib-related AEs was 12 days (interquartile range [IQR] 1-62 days), and had early failure types. CONCLUSION Our study demonstrated potential new AEs of rucaparib, and further studies were expected to confirm the results.
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Affiliation(s)
- Qilin Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yiling Ding
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, 113-0033, Japan
| | - Yamin Shu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, 430030, China.
| | - Jing Chen
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, 430030, China.
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19
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Derenzini E, Gueli A, Risso A, Bruna R, Gottardi D, Cignetti A, Pileri S, Avvedimento EV, Tarella C. Long telomeres at baseline and male sex are main determinants of telomere loss following chemotherapy exposure in lymphoma patients. Hematol Oncol 2023; 41:335-342. [PMID: 36533316 DOI: 10.1002/hon.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Although chemotherapy (CHT) exposure is an established cause of telomere attrition, determinants of telomere length (TL) dynamics after chemotherapy are poorly defined. In this study, we analyzed granulocyte telomere dynamics in 34 adult lymphoma patients undergoing first-line CHT. TL was measured by southern blot at each CHT cycle and after 1 year from CHT completion. Median age was 59 yrs (range 22-77). Median number of CHT cycles was 6 (range 3-6). The majority of patients (79%, n = 27) experienced TL shortening following CHT exposure. Mean telomere loss was 673 base pairs (bp) by cycle 6. Telomere shortening was an early event as 87% of the total telomere loss (mean 586 bp) occurred by the end of cycle 3, with no significant recovery after 1 year. A significant correlation was observed between baseline TL and total or fractional telomere loss (p < 0.001), with telomere shortening by cycle 3 observed predominantly in male patients with long telomeres at pre-treatment evaluation. Stratifying the analysis by gender and age only young women (<51 years of age) did not show significant telomere shortening following chemotherapy exposure. These findings indicate that gender and baseline TL are major determinants of TL dynamics following chemotherapy exposure in lymphoma patients.
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Affiliation(s)
- Enrico Derenzini
- Onco-Hematology Division, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Angela Gueli
- Internal Medicine Unit, Ciriè Hospital, Turin, Italy
| | - Alessandra Risso
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - Riccardo Bruna
- Department of Translational Medicine, University of Eastern Piedmont and Ospedale Maggiore della Carità, Novara, Italy
| | - Daniela Gottardi
- Hematology and Cell Therapy, A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, Turin, Italy
| | - Alessandro Cignetti
- Hematology and Cell Therapy, A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, Turin, Italy
| | - Stefano Pileri
- Division of diagnostic Haematopathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico V Avvedimento
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II, Napoli, Italy
| | - Corrado Tarella
- Onco-Hematology Division, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
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20
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Tong J, Aksenov S, Siegel BM, Wei L, Rodgers WH. A Rare Case of Blastic Plasmacytoid Dendritic Cell Neoplasm Occurred in Postchemotherapy of Breast Cancer. Case Rep Hematol 2023; 2023:7573037. [PMID: 37457315 PMCID: PMC10344635 DOI: 10.1155/2023/7573037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions and may involve peripheral blood, bone marrow, lymph nodes, or extranodal sites. It usually arises de novo, and some BPDCN cases are associated with or develop into myeloid neoplasms. Here, we report a case of a 57-year-old female presenting with cervical lymphadenopathy and skin rashes during the COVID-19 pandemic in 2021 following multiple types of postmastectomy therapy for breast cancer. The patient was ultimately diagnosed with BPCDN by lymph node biopsy. To the best of our knowledge, this is the first case report of BPDCN occurring postchemotherapy of breast cancer.
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Affiliation(s)
- Jiankun Tong
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Sergei Aksenov
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Beth M. Siegel
- Department of Surgery, Section of Breast Surgery, New York Presbyterian Queens, 58-04 Main Street, Flushing, NY 11355, USA
| | - Lihong Wei
- Consultant Hematology & Medical Oncology, Queens Medical Associates, 176-60 Union Tpke # 360, Fresh Meadows, NY 11366, USA
| | - William H. Rodgers
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
- Weill Cornell Medical College, 525 East 68th Street, Box 130, New York, NY 10065, USA
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21
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Kim HJ, Lee J, Park IC, Han Y, Seong MK, Noh WC, Kang HJ, Kim HA, Park CS. Survival analysis of breast cancer patients after diagnosis of second primary malignancies, focusing on the second primary hematologic malignancy. Ann Surg Treat Res 2023; 105:1-9. [PMID: 37441319 PMCID: PMC10333803 DOI: 10.4174/astr.2023.105.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose Although the overall survival (OS) of breast cancer patients is increasing with improved detection and therapies, so is the risk of breast cancer patients developing subsequent malignancies. We investigated the OS of breast cancer survivors according to sites of second primary malignancies (SPM). The OS of the second primary hematologic malignancy (SPHM) was then compared with that of metastatic breast cancer (MBC). Methods We retrospectively analyzed patients diagnosed with primary breast cancer between 1998 and 2019. Only those with SPM were eligible for analysis. First, the OS of patients with SPM diagnosed as the first event after the diagnosis of breast cancer was analyzed. Next, the OS of patients with SPHM, with or without breast cancer relapse, was compared with that of patients with MBC, matched using the propensity score. Results Patients diagnosed with SPM without breast cancer relapse as the first event had a significantly better OS than did patients with MBC, but the OS of those with SPHM as the first event did not differ significantly from that of patients with MBC (hazard ratio [HR], 1.558; 95% confidence interval [CI], 0.856-2.839; P = 0.147). The OS of patients with SPHM with or without breast cancer relapse was worse than that of the MBC group after propensity score matching (HR, 1.954; 95% CI, 1.045-3.654; P = 0.036). Conclusion Prognosis of SPM diagnosed as the first event was statistically better than that of MBC, except in case of SPHM. Patients with SPHM, with or without MBC, showed poor OS before and after propensity score matching.
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Affiliation(s)
- Hyung Jin Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Juhyeon Lee
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - In-Chul Park
- Division of Fusion Radiology Research, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Yireh Han
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Woo Chul Noh
- Department of Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Hye Jin Kang
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chan Sub Park
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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22
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Morton LM, Curtis RE, Linet MS, Schonfeld SJ, Advani PG, Dalal NH, Sasse EC, Dores GM. Trends in risk for therapy-related myelodysplastic syndrome/acute myeloid leukemia after initial chemo/immunotherapy for common and rare lymphoid neoplasms, 2000-2018. EClinicalMedicine 2023; 61:102060. [PMID: 37457112 PMCID: PMC10344829 DOI: 10.1016/j.eclinm.2023.102060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background Historically, survivors of common lymphoid neoplasms (LNs) had increased risks for therapy-related myelodysplastic syndrome/acute myeloid leukemia (tMDS/AML). Despite major treatment advances in the treatment of LNs over the last two decades, a comprehensive evaluation of tMDS/AML trends following both common and rare LNs treated in this contemporary period is lacking. Methods In US cancer registries during 2000-2018, we identified 1496 tMDS/AML cases among 186,503 adults who were treated with initial chemo/immunotherapy for first primary LN and survived ≥1 year. We quantified tMDS/AML standardized incidence ratios (SIRs), excess absolute risks (EARs, per 10,000 person-years), and cumulative incidence. Findings The highest tMDS/AML risks occurred after precursor leukemia/lymphoma (SIR = 39, EAR = 30), Burkitt leukemia/lymphoma (SIR = 20, EAR = 24), peripheral T-cell lymphoma (SIR = 12, EAR = 23), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; SIR = 9.0, EAR = 27), and mantle cell lymphoma (SIR = 8.5, EAR = 25). Elevated risks (SIRs = 4.2-6.9, EARs = 4.9-15) also were observed after all other LN subtypes except hairy cell leukemia and mycosis fungoides/Sézary syndrome. Among patients treated more recently, tMDS/AML risks were significantly higher after CLL/SLL (SIR2000-2005 = 4.8, SIR2012-2017 = 10, Ptrend = 0.0043), significantly lower after Hodgkin (SIR2000-2005 = 15, SIR2012-2017 = 6.3, Ptrend = 0.024) and marginal zone (SIR2000-2005 = 7.5, SIR2012-2017 = 2.3, Ptrend = 0.015) lymphomas, and non-significantly lower after mantle cell lymphoma (SIR2000-2005 = 10, SIR2012-2017 = 3.2, Ptrend = 0.054), lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (SIR2000-2005 = 6.9, SIR2012-2017 = 1.0, Ptrend = 0.067), and plasma cell neoplasms (SIR2000-2005 = 5.4, SIR2012-2017 = 3.1, Ptrend = 0.051). EAR and cumulative incidence trends generally were similar to SIR trends. Median survival after tMDS/AML was 8.0 months (interquartile range, 3.0-22.0). Interpretation Although tMDS/AML risks are significantly elevated after initial chemo/immunotherapy for most LNs, patients treated more recently have lower tMDS/AML risks, except after CLL/SLL. Though rare, the poor prognosis following tMDS/AML emphasizes the importance of continued efforts to reduce treatment-associated toxicity. Funding This research was supported in part by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. LMM, GMD, REC, and CBS verified the data, and all authors had access to the data and made the decision to submit for publication.
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Affiliation(s)
- Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Rochelle E. Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Sara J. Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Pragati G. Advani
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nicole H. Dalal
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Internal Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Elizabeth C. Sasse
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Graça M. Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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23
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Razik M, Rozwadowska P, Koclęga A, Helbig G. Double Malignancy and Double Transplant-A Bumpy Road to Success. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1209. [PMID: 37512021 PMCID: PMC10384397 DOI: 10.3390/medicina59071209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
The occurrence of secondary neoplasms in adult patients treated with chemotherapy in childhood is not uncommon. Prior chemotherapy is found to be an independent risk factor for the development of secondary malignancies, which are usually associated with a worse prognosis. The presented case is a 35-year-old female patient who was diagnosed with Ewing sarcoma in her late adolescence. The tumor was successfully treated with chemotherapy, but 3 years later she was diagnosed with T-cell lymphoblastic lymphoma. The patient received allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leukocyte antigen (HLA) matched related donor. The procedure was complicated by grade 2 acute graft-versus-host disease (GvHD) which resolved after implementation of immunosuppressive treatment. However, a year later, the patient developed extensive chronic GvHD (cGvHD) and required reintroduction of immunosuppressants. Prolonged immunosuppressive treatment with tacrolimus led to irreversible kidney failure. After a 2-year period of regular peritoneal dialysis, she was found to be eligible for a kidney transplant from a deceased donor. Now, 15 years after stem cell transplantation and 8 years after kidney transplantation, the patient remains in good condition overall, presenting with symptoms of limited cGvHD. The case described here presents a unique clinical scenario of a female patient who was successfully treated for her double malignancy. Moreover, she underwent effective double transplantations and was eventually found to be cured despite accompanying complications.
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Affiliation(s)
- Michał Razik
- Students' Research Group, Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Patrycja Rozwadowska
- Students' Research Group, Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Koclęga
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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24
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Shen C, Zhang K, Yang J, Shi J, Yang C, Sun Y, Yang W. Association between metal(loid)s in serum and leukemia: a systematic review and meta-analysis. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2023; 21:201-213. [PMID: 37159736 PMCID: PMC10163180 DOI: 10.1007/s40201-023-00853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 05/11/2023]
Abstract
Purpose Heavy metals and metalloids are recognized as environmental threats, which are considered highly toxic and carcinogenic. Epidemiologically, their association with leukemia is under debate. We aim to clarify the association between the heavy metal(loid)s in serum and leukemia via a systematic review and meta-analysis. Methods We searched PubMed, Embase, Google Scholar, and CNKI (China National Knowledge Infrastructure) databases for all related articles. The standardized mean difference and its 95% confidence interval was used to evaluate the association of leukemia with heavy metal(loid)s in serum. The statistical heterogeneity among studies was assessed with the Q-test and I 2 statistics. Results Among 4,119 articles related to metal(loid)s and leukemia, 21 studies met our inclusion criteria, which are all cross-sectional studies. These 21 studies involved 1,316 cases and 1,310 controls, based on which we evaluate the association of heavy metals/metalloids in serum with leukemia. Our results indicated positive differences for serum chromium, nickel, and mercury in leukemia patients, while a negative difference for serum manganese in acute lymphocytic leukemia (ALL). Conclusion Our results suggested an elevated trend of serum chromium, nickel, and mercury concentrations in leukemia patients while descending trend of serum manganese concentration in ALL patients. The result of sensitivity analysis between lead, cadmium, and leukemia and publication bias of association between chromium and leukemia also needed attention. Future research work may focus on the dose-response relationship between any of these elements and the leukemia risks, and further elucidation of how these elements are related to leukemia may shed light on the prevention and treatment of leukemia. Supplementary Information The online version contains supplementary material available at 10.1007/s40201-023-00853-2.
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Affiliation(s)
- Chengchen Shen
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Kui Zhang
- Department of Forensic Pathology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Jingxuan Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Jingyi Shi
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Chan Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Yanan Sun
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
| | - Wenxing Yang
- Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, 610041 Chengdu, Sichuan People’s Republic of China
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25
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Ramin C, Veiga LHS, Vo JB, Curtis RE, Bodelon C, Aiello Bowles EJ, Buist DSM, Weinmann S, Feigelson HS, Gierach GL, Berrington de Gonzalez A. Risk of second primary cancer among women in the Kaiser Permanente Breast Cancer Survivors Cohort. Breast Cancer Res 2023; 25:50. [PMID: 37138341 PMCID: PMC10155401 DOI: 10.1186/s13058-023-01647-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Breast cancer survivors are living longer due to early detection and advances in treatment and are at increased risk for second primary cancers. Comprehensive evaluation of second cancer risk among patients treated in recent decades is lacking. METHODS We identified 16,004 females diagnosed with a first primary stage I-III breast cancer between 1990 and 2016 (followed through 2017) and survived ≥ 1 year at Kaiser Permanente (KP) Colorado, Northwest, and Washington. Second cancer was defined as an invasive primary cancer diagnosed ≥ 12 months after the first primary breast cancer. Second cancer risk was evaluated for all cancers (excluding ipsilateral breast cancer) using standardized incidence ratios (SIRs), and a competing risk approach for cumulative incidence and hazard ratios (HRs) adjusted for KP center, treatment, age, and year of first cancer diagnosis. RESULTS Over a median follow-up of 6.2 years, 1,562 women developed second cancer. Breast cancer survivors had a 70% higher risk of any cancer (95%CI = 1.62-1.79) and 45% higher risk of non-breast cancer (95%CI = 1.37-1.54) compared with the general population. SIRs were highest for malignancies of the peritoneum (SIR = 3.44, 95%CI = 1.65-6.33), soft tissue (SIR = 3.32, 95%CI = 2.51-4.30), contralateral breast (SIR = 3.10, 95%CI = 2.82-3.40), and acute myeloid leukemia (SIR = 2.11, 95%CI = 1.18-3.48)/myelodysplastic syndrome (SIR = 3.25, 95%CI = 1.89-5.20). Women also had elevated risks for oral, colon, pancreas, lung, and uterine corpus cancer, melanoma, and non-Hodgkin lymphoma (SIR range = 1.31-1.97). Radiotherapy was associated with increased risk for all second cancers (HR = 1.13, 95%CI = 1.01-1.25) and soft tissue sarcoma (HR = 2.36, 95%CI = 1.17-4.78), chemotherapy with decreased risk for all second cancers (HR = 0.87, 95%CI = 0.78-0.98) and increased myelodysplastic syndrome risk (HR = 3.01, 95%CI = 1.01-8.94), and endocrine therapy with lower contralateral breast cancer risk (HR = 0.48, 95%CI = 0.38-0.60). Approximately 1 in 9 women who survived ≥ 1 year developed second cancer, 1 in 13 developed second non-breast cancer, and 1 in 30 developed contralateral breast cancer by 10 years. Trends in cumulative incidence declined for contralateral breast cancer but not for second non-breast cancers. CONCLUSIONS Elevated risks of second cancer among breast cancer survivors treated in recent decades suggests that heightened surveillance is warranted and continued efforts to reduce second cancers are needed.
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Affiliation(s)
- Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA.
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Heather Spencer Feigelson
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
- Division of Genetics and Epidemiology, ICR, London, UK
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26
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Damiani D, Tiribelli M. ABCG2 in Acute Myeloid Leukemia: Old and New Perspectives. Int J Mol Sci 2023; 24:ijms24087147. [PMID: 37108308 PMCID: PMC10138346 DOI: 10.3390/ijms24087147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Despite recent advances, prognosis of acute myeloid leukemia (AML) remains unsatisfactory due to poor response to therapy or relapse. Among causes of resistance, over-expression of multidrug resistance (MDR) proteins represents a pivotal mechanism. ABCG2 is an efflux transporter responsible for inducing MDR in leukemic cells; through its ability to extrude many antineoplastic drugs, it leads to AML resistance and/or relapse, even if conflicting data have been reported to date. Moreover, ABCG2 may be co-expressed with other MDR-related proteins and is finely regulated by epigenetic mechanisms. Here, we review the main issues regarding ABCG2 activity and regulation in the AML clinical scenario, focusing on its expression and the role of polymorphisms, as well as on the potential ways to inhibit its function to counteract drug resistance to, eventually, improve outcomes in AML patients.
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Affiliation(s)
- Daniela Damiani
- Division of Hematology and Stem Cell Transplantation, Udine Hospital, P.le Santa Maria della Misericordia, 5, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Mario Tiribelli
- Division of Hematology and Stem Cell Transplantation, Udine Hospital, P.le Santa Maria della Misericordia, 5, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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27
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Moreno Berggren D, Garelius H, Willner Hjelm P, Nilsson L, Rasmussen B, Weibull CE, Lambe M, Lehmann S, Hellström-Lindberg E, Jädersten M, Ejerblad E. Therapy-related MDS dissected based on primary disease and treatment-a nationwide perspective. Leukemia 2023; 37:1103-1112. [PMID: 36928008 PMCID: PMC10169633 DOI: 10.1038/s41375-023-01864-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
In this population-based study, we aimed to characterize and compare subgroups of therapy-related Myelodysplastic syndromes (t-MDS) and define the implications of type of previous treatment and primary disease. We combined data from MDS patients, diagnosed between 2009 and 2017 (n = 2705), in the nationwide Swedish MDS register, with several health registers. Furthermore, using matched population controls, we investigated the prevalence of antecedent malignancies in MDS patients in comparison with the general population. This first ever nationwide study on t-MDS confirms a shorter median survival for t-MDS compared to de novo MDS (15.8 months vs 31.1 months, p < 0.001). T-MDS patients previously treated with radiation only had disease characteristics with a striking resemblance to de novo-MDS, in sharp contrast to patients treated with chemotherapy who had a significantly higher risk profile. IPSS-R and the WHO classification differentiated t-MDS into different risk groups. As compared with controls, MDS patients had a six-fold increased prevalence of a previous hematological malignancy but only a 34% increased prevalence of a previous solid tumor. T-MDS patients with a previous hematological malignancy had a dismal prognosis, due both to mortality related to their primary disease and to high-risk MDS.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden.
| | - Hege Garelius
- Section of Hematology and Coagulation, Department of Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline E Weibull
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm and Regional Cancer Center Central Sweden, Uppsala, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
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28
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Lauritsen TB, Nørgaard JM, Dalton SO, Grønbæk K, El-Galaly TC, Østgård LSG. 10-year nationwide trends in incidence, treatment patterns, and mortality of patients with myelodysplastic syndromes in Denmark. Leuk Res 2023; 128:107056. [PMID: 36963210 DOI: 10.1016/j.leukres.2023.107056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
Further temporal data on incidence, treatment patterns, and prognosis for patients with myelodysplastic syndromes (MDS) are needed. This study examined 10-year trends in incidence, treatment patterns, and all-cause mortality in a population-based cohort of 2309 MDS patients using Danish nationwide registries (2010-2019). We computed annual incidence rates overall and according to sex and age-groups. We examined temporal changes in the cumulative incidence of MDS specific treatments initiated within one year from diagnosis and temporal changes in the absolute risk of death and five-year adjusted hazard ratios (aHRs) for death, adjusting for age, sex and comorbidity. The age-standardized incidence rate of MDS per 100,000 person-years increased slightly from 5.3 in 2010 to 6.4 in 2019. Between 2010-2012 to 2016-2017, the use of azacitidine increased overall (8% to 22%), in patients with intermediate risk MDS (12% to 34%), and in patients with high-risk MDS (22% to 50%), while it remained stable (around 5%) for patients with low-risk MDS. The five-year aHR for death in the most recent calendar period compared to the earliest calendar period remained unchanged in patients with low-risk MDS, aHR = 0.90 (95% CI, 0.72-1.12) and in patients with high-risk MDS, aHR = 1.19 (95% CI, 0.89-1.61), while survival improved over time among patients with intermediate risk MDS, aHR = 0.67 (95% CI, 0.48-0.92). In conclusion the incidence of MDS slightly increased during a 10-year period in Denmark. The use of azacitidine increased markedly but five-year overall survival remained unchanged.
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Affiliation(s)
| | | | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Denmark; Biotech Research and Innovation Centre, BRIC, University of Copenhagen, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborgī, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Denmark; Department of Hematology, Odense University Hospital, Denmark
| | - Lene Sofie Granfeldt Østgård
- Department of Hematology, Odense University Hospital, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
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29
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Odani S, Nakata K, Inoue M, Kato M, Saito MK, Morishima T, Hashii Y, Hara J, Kawa K, Miyashiro I. Incidence of second primary cancers among survivors of childhood cancer: A population-based study, Osaka, Japan, 1975-2015. Cancer Sci 2023; 114:1142-1153. [PMID: 36345911 PMCID: PMC9986077 DOI: 10.1111/cas.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Second primary cancer (SPC) is one of the most life-threatening late effects of childhood cancers. We investigated the incidence and survival outcomes of SPC in childhood cancer patients in Japan. Data were obtained from the population-based Osaka Cancer Registry. Individuals diagnosed with cancer at age 0-14 years during 1975-2014 and survived 2 months or longer were followed through December 2015. The risk of developing SPC was assessed with standardized incidence ratio (SIR), excess absolute risk (EAR, per 100,000 person-years), and cumulative incidence. Multivariable Poisson regression analysis was carried out to assess relative risks of SPC by treatment method. Survival analysis was undertaken using the Kaplan-Meier method. Of 7229 childhood cancer survivors, 101 (1.4%) developed SPC after a median of 11.6 years. Overall SIR was 5.0, which corresponded with 84.3 EAR. The cumulative incidence was 0.9%, 2.1%, and 3.4% at 10, 20, and 30 years, respectively. Among all SPCs, the type that contributed most to the overall burden was cancers in the central nervous system (EAR = 28.0) followed by digestive system (EAR = 15.1), thyroid (EAR = 8.3), and bones and joints (EAR = 7.8); median latency ranged from 2.0 years (lymphomas) to 26.6 years (skin cancers). Patients treated with radiotherapy alone were at a 2.58-fold increased risk of developing SPC compared to those who received neither chemotherapy nor radiotherapy. Among patients who developed SPCs, 5-year and 10-year survival probabilities after SPC diagnosis were 61.7% and 52.0%, respectively. Risk-based long-term follow-up planning is essential to inform survivorship care and help reduce the burden of SPCs in childhood cancer survivors.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Mizuki Kato
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | | | - Yoshiko Hashii
- Department of Pediatrics, Osaka International Cancer Institute, Osaka, Japan
| | - Junich Hara
- Department of Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka, Japan
| | - Keisei Kawa
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,Graduate School of Medicine, Osaka University, Osaka, Japan
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30
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Falini B, Martelli MP. Comparison of the International Consensus and 5th WHO edition classifications of adult myelodysplastic syndromes and acute myeloid leukemia. Am J Hematol 2023; 98:481-492. [PMID: 36606297 DOI: 10.1002/ajh.26812] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
Several editions of the World Health Organization (WHO) classifications of lympho-hemopoietic neoplasms in 2001, 2008, and 2016 served as the international standard for diagnosis. Since the 4th WHO edition, here referred as WHO-HAEM4, significant clinico-pathological, immunophenotypic, and molecular advances have been made in the field of myeloid neoplasms, which have contributed to refine diagnostic criteria, to upgrade entities previously defined as provisional and to identify new entities. This process has resulted in two recent classification proposals of myeloid neoplasms: the International Consensus Classification (ICC) and the 5th edition of the WHO classification (WHO-HAEM5). In this paper, we review and compare the two classifications in terms of diagnostic criteria and entity definition, with a focus on adult myelodysplastic syndromes/neoplasms (MDS) and acute myeloid leukemia (AML). The goal is to provide a tool to facilitate the work of pathologists, hematologists and researchers involved in the diagnosis and treatment of these hematological malignancies.
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Affiliation(s)
- Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncological research (CREO), University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Paola Martelli
- Institute of Hematology and Center for Hemato-Oncological research (CREO), University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
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31
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Dores GM, Linet MS, Curtis RE, Morton LM. Risks of therapy-related hematologic neoplasms beyond myelodysplastic syndromes and acute myeloid leukemia. Blood 2023; 141:951-955. [PMID: 36379026 PMCID: PMC10082352 DOI: 10.1182/blood.2022018051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/19/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Graça M. Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rochelle E. Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
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32
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Caruso G, Gigli F, Parma G, Lapresa M, Derio S, Palaia I, Colombo N. Myeloid neoplasms post PARP inhibitors for ovarian cancer. Int J Gynecol Cancer 2023; 33:598-606. [PMID: 36707087 DOI: 10.1136/ijgc-2022-004190] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The incidence of myeloid neoplasms following treatment with poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with ovarian cancer has been gradually increasing over the last few years. The cumulative exposure to PARPi and the improved overall survival of patients with ovarian cancer may represent key underlying explanations behind such trend. Fortunately, the earlier introduction of PARPi in the frontline setting reduces the risk of developing secondary myeloid neoplasms. The etiopathogenesis is still unclear but is likely to be multifactorial. The first 2 years of PARPi exposure seem to be the critical window for the onset of myeloid neoplasms post PARPi, with persistent cytopenia recognized as an early warning sign. Despite intensive treatment strategies, the outcome remains poor. There is an unmet clinical need to learn how to minimize risk, make an early diagnosis, and manage myeloid neoplasms post PARPi. First, decision making regarding the optimal maintenance treatment should avoid a 'PARPi-for-all' strategy. PARPi should be used cautiously in cases of high baseline risk for myeloid neoplasms and/or patients who are less likely to have a benefit. Active surveillance, accurate differential diagnosis, and prompt hematological referral are key management pillars. This review discusses what is known on this emerging issue as well as unresolved questions.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy .,Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Federica Gigli
- Onco-Hematology Division, European Institute of Oncology, Milan, Italy
| | - Gabriella Parma
- Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | | | - Silvia Derio
- Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit, University of Milan Bicocca, European Institute of Oncology, Milan, Italy
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33
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Marmouset V, Decroocq J, Garciaz S, Etienne G, Belhabri A, Bertoli S, Gastaud L, Simand C, Chantepie S, Uzunov M, Genthon A, Berthon C, Chiche E, Dumas PY, Vargaftig J, Salmeron G, Lemasle E, Tavernier E, Delage J, Loirat M, Morineau N, Blanc-Durand F, Pautier P, Vergé V, Auger N, Thomas M, Stefani L, Lepelley M, Boyer T, Thepot S, Gourin MP, Bourquard P, Duchmann M, Morice PM, Michallet M, Adès L, Fenaux P, Récher C, Dombret H, Pagès A, Marzac C, Leary A, Micol JB. Therapy-related Myeloid Neoplasms Following PARP Inhibitors: Real-life Experience. Clin Cancer Res 2022; 28:5211-5220. [PMID: 36201165 DOI: 10.1158/1078-0432.ccr-22-1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/27/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To provide insights into the diagnosis and management of therapy-related myeloid neoplasms (t-MN) following PARP inhibitors (PARPi). EXPERIMENTAL DESIGN In a French cancer center, we identified and described the profiles of 13 t-MN diagnosed among 37 patients with ovarian cancer referred to hematology consultation for cytopenia under PARPi. Next, we described these 13 t-MN post-PARPi among 37 t-MN post ovarian cancer according to PARPi exposure. Finally, we described 69 t-MN post-PARPi in a national cohort. RESULTS From 2016 to 2021, cumulative incidence of t-MN was 3.5% (13/373) among patients with ovarian cancer treated with PARPi. At time of hematologic consultation, patients with t-MN had a longer PARPi exposure (9 vs. 3 months, P = 0.01), lower platelet count (74 vs. 173 G/L, P = 0.0005), and more cytopenias (2 vs. 1, P = 0.0005). Compared with t-MN not exposed to PARPi, patients with t-MN-PARPi had more BRCA1/2 germline mutation (61.5% vs. 0%, P = 0.03) but similar overall survival (OS). In the national cohort, most t-MN post-PARPi had a complex karyotype (61%) associated with a high rate of TP53 mutation (71%). Median OS was 9.6 months (interquartile range, 4-14.6). In multivariate analysis, a longer time between end of PARPi and t-MN (HR, 1.046; P = 0.02), olaparib compared with other PARPi (HR, 5.82; P = 0.003) and acute myeloid leukemia (HR, 2.485; P = 0.01) were associated with shorter OS. CONCLUSIONS In a large series, we described a high incidence of t-MN post-PARPi associated with unfavorable cytogenetic and molecular abnormalities leading to poor OS. Early detection is crucial, particularly in cases of delayed cytopenia.
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Affiliation(s)
- Vincent Marmouset
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Justine Decroocq
- Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service d'Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Sylvain Garciaz
- Institut Paoli Calmettes, Marseille, France
- Cancer Research Center of Marseille, INSERM U1068, Aix-Marseille University, Marseille, France
| | | | - Amine Belhabri
- Department of Oncology, Centre Leon Berard, Lyon, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Célestine Simand
- Department of Hematology, Institute for Cancer Strasbourg-Europe (ICANS), Strasbourg University, Strasbourg, France
| | - Sylvain Chantepie
- Department of Clinical Hematology, Caen University Hospital, Caen, France
| | - Madalina Uzunov
- Service d'hématologie adulte, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexis Genthon
- Department of Clinical Hematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR-S 938, Paris, France
| | - Céline Berthon
- Department of Hematology, CHU Lille, Lille, France
- University of Lille, CNRS, Inserm, CHU Lille, IRCL, UMR9020 - UMR1277 - Canther - Cancer heterogeneity, plasticity and resistance to therapies, Lille, France
| | | | - Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | | | | | - Emilie Lemasle
- Département d'hématologie, Hôpital Henri Becquerel, Rouen, France
| | - Emmanuelle Tavernier
- Hématologie, Institut de Cancérologie-Hématologie Universitaire de Saint Etienne, France
| | - Jérémy Delage
- Département d'hématologie clinique, Saint Eloi, Montpellier, France
| | - Marion Loirat
- Service d'hématologie, Hôpital Saint Nazaire, Saint-Nazaire, France
| | | | - Félix Blanc-Durand
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Pautier
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Véronique Vergé
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nathalie Auger
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | - Marion Lepelley
- Centre Régional de Pharmacovigilance - Addictovigilance, CHU de Grenoble-Alpes, France
| | - Thomas Boyer
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | | | | | | | - Matthieu Duchmann
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique Unité (U)944, INSERM, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Pierre-Marie Morice
- Department of Clinical Hematology, Caen University Hospital, Caen, France
- UNICAEN, INSERM U1086 ANTICIPE (Interdisciplinary Research Unit for Cancer Prevention and Treatment), Normandie University, Caen, France
| | | | - Lionel Adès
- Hématologie Sénior Hôpital Saint Louis, Assistance publique hôpitaux de paris, and Université de Paris Cité, Paris, France
| | - Pierre Fenaux
- Hématologie Sénior Hôpital Saint Louis, Assistance publique hôpitaux de paris, and Université de Paris Cité, Paris, France
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Hervé Dombret
- Adult Hematology Department, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Arnaud Pagès
- Bureau de Biostatistique et d'Épidémiologie - Gustave Roussy Équipe Oncostat - CESP U1018 - Inserm, France
| | - Christophe Marzac
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alexandra Leary
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Baptiste Micol
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U1287, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Baranwal A, Hahn CN, Shah MV, Hiwase DK. Role of Germline Predisposition to Therapy-Related Myeloid Neoplasms. Curr Hematol Malig Rep 2022; 17:254-265. [PMID: 35986863 DOI: 10.1007/s11899-022-00676-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Therapy-related myeloid neoplasms (t-MNs) are aggressive leukemias that develop following exposure to DNA-damaging agents. A subset of patients developing t-MN may have an inherited susceptibility to develop myeloid neoplasia. Herein, we review studies reporting t-MN and their association with a germline or inherited predisposition. RECENT FINDINGS Emerging evidence suggests that development of t-MN is the result of complex interactions including generation of somatic variants in hematopoietic stem cells and/or clonal selection pressure exerted by the DNA-damaging agents, and immune evasion on top of any inherited genetic susceptibility. Conventionally, alkylating agents, topoisomerase inhibitors, and radiation have been associated with t-MN. Recently, newer modalities including poly (ADP-ribose) polymerase inhibitors (PARPi) and peptide receptor radionucleotide therapy (PRRT) are associated with t-MN. At the same time, the role of pathogenic germline variants (PGVs) in genes such as BRCA1/2, BARD1, or TP53 on the risk of t-MN is being explored. Moreover, studies have shown that while cytotoxic therapy increases the risk of developing myeloid neoplasia, it may be exposing the vulnerability of an underlying germline predisposition. t-MN remains a disease with poor prognosis. Studies are needed to better define an individual's inherited neoplastic susceptibility which will help predict the risk of myeloid neoplasia in the future. Understanding the genes driving the inherited neoplastic susceptibility will lead to better patient- and cancer-specific management including choice of therapeutic regimen to prevent, or at least delay, development of myeloid neoplasia after treatment of a prior malignancy.
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Affiliation(s)
- Anmol Baranwal
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55906, USA
| | - Christopher N Hahn
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia.,Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Mithun Vinod Shah
- Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55906, USA.
| | - Devendra K Hiwase
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia. .,Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia. .,South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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Abstract
Myelodysplastic syndromes (MDS) are a family of myeloid cancers with diverse genotypes and phenotypes characterized by ineffective haematopoiesis and risk of transformation to acute myeloid leukaemia (AML). Some epidemiological data indicate that MDS incidence is increasing in resource-rich regions but this is controversial. Most MDS cases are caused by randomly acquired somatic mutations. In some patients, the phenotype and/or genotype of MDS overlaps with that of bone marrow failure disorders such as aplastic anaemia, paroxysmal nocturnal haemoglobinuria (PNH) and AML. Prognostic systems, such as the revised International Prognostic Scoring System (IPSS-R), provide reasonably accurate predictions of survival at the population level. Therapeutic goals in individuals with lower-risk MDS include improving quality of life and minimizing erythrocyte and platelet transfusions. Therapeutic goals in people with higher-risk MDS include decreasing the risk of AML transformation and prolonging survival. Haematopoietic cell transplantation (HCT) can cure MDS, yet fewer than 10% of affected individuals receive this treatment. However, how, when and in which patients with HCT for MDS should be performed remains controversial, with some studies suggesting HCT is preferred in some individuals with higher-risk MDS. Advances in the understanding of MDS biology offer the prospect of new therapeutic approaches.
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Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood 2022; 140:1345-1377. [PMID: 35797463 DOI: 10.1182/blood.2022016867] [Citation(s) in RCA: 951] [Impact Index Per Article: 475.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
The 2010 and 2017 editions of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults are widely recognized among physicians and investigators. There have been major advances in our understanding of AML, including new knowledge about the molecular pathogenesis of AML, leading to an update of the disease classification, technological progress in genomic diagnostics and assessment of measurable residual disease, and the successful development of new therapeutic agents, such as FLT3, IDH1, IDH2, and BCL2 inhibitors. These advances have prompted this update that includes a revised ELN genetic risk classification, revised response criteria, and treatment recommendations.
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Ha H, Kim HJ, Park JH, Shin A, Lee KN, Han K, Lee NR, Hong J. Epidemiologic outlook of therapy-related myeloid neoplasms and selection of high-risk patients: A Korean nationwide study. Cancer 2022; 128:3888-3896. [PMID: 36069361 DOI: 10.1002/cncr.34453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although a considerable proportion of patients with cancer receive chemotherapy (CT) or radiotherapy (RT), only a very few patients eventually develop therapy-related myeloid neoplasms (t-MNs). METHODS To identify subsets of cancer patients who have substantially elevated risk of developing t-MNs. Incidences and risks of t-MNs after contemporary CT or RT in patients newly diagnosed major cancers during 2009-2013 were analyzed. By merging two Korean nationwide health care big data sets, patients were selected and observed on follow-up to until t-MN development or December 2019. RESULTS Among 250,155 patients, 555 (0.22%) were diagnosed with t-MNs with a standard incidence ratio (SIR) of 3.40 (95% CI, 3.13-3.70). Patients had bone/joint cancers (SIR, 94.25; 95% CI, 50.71-137.80) and a remarkably high SIR for t-MN development. Patients receiving both CT and RT had the highest SIR (4.64; 95% CI, 4.08-5.20), followed by those receiving CT only (SIR, 3.30; 95% CI, 2.89-3.70). Contrarily, RT alone did not increase t-MN risk (SIR, 1.16; 95% CI, 0.76-1.56). More exposure to leukemogenic agents resulted in the higher t-MNs development. CONCLUSIONS The increased risk of developing acute myeloid leukemia or myelodysplastic syndrome after CT and/or RT was confirmed and subsets with substantially elevated risk for developing t-MNs were found. Such patients would be suitable for a prospective cohort for investigating t-MN pathogenesis by time series analyses.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hyo Jeong Kim
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Ju Hyun Park
- Korea Institute for Health and Social Affairs (KIHASA), Sejong-si, South Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Na Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yamaoka K, Fujiwara M, Uchida M, Uesawa Y, Muroi N, Shimizu T. Comprehensive Analysis of Adverse Events Induced by PARP Inhibitors Using JADER and Time to Onset. Life (Basel) 2022; 12:life12091355. [PMID: 36143391 PMCID: PMC9504973 DOI: 10.3390/life12091355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Poly (ADP-ribose) polymerase (PARP) inhibitors are effective against breast cancer susceptibility gene (BRCA) mutations. Clinical trials have reported hematologic toxicity and gastrointestinal symptoms as class effects of PARP inhibitors. However, information on adverse events (AEs) in a Japanese clinical cohort is currently lacking. In this study, we conducted a comprehensive survey of the AEs of two PARP inhibitors, olaparib and niraparib, using the Japanese Adverse Reaction Reporting (JADER) database provided by the Pharmaceuticals and Medical Devices Agency (PMDA). Moreover, we also analyzed the course and time to the onset of AEs. Signals were detected for 15 and 11 AEs for olaparib and niraparib, respectively. Most occurred within the first month of treatment with either agent. These results may indicate the importance of early response and monitoring after beginning PARP inhibitor therapy. The results of this study may be useful for managing side effects and suggesting supportive care for patients using PARP inhibitors in the future.
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Affiliation(s)
- Kenta Yamaoka
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
- School of Pharmacy, Hyogo Medical University, Kobe 650-8530, Japan
| | - Masaki Fujiwara
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
- School of Pharmacy, Hyogo Medical University, Kobe 650-8530, Japan
| | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyotanabe 610-0395, Japan
| | - Yoshihiro Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo 204-8588, Japan
| | - Nobuyuki Muroi
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Tadashi Shimizu
- School of Pharmacy, Hyogo Medical University, Kobe 650-8530, Japan
- Correspondence:
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Therapy-related clonal cytopenia as a precursor to therapy-related myeloid neoplasms. Blood Cancer J 2022; 12:106. [PMID: 35803921 PMCID: PMC9270475 DOI: 10.1038/s41408-022-00703-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
Therapy-related myeloid neoplasms (t-MN) are aggressive leukemia that develops as a complication of prior exposure to DNA-damaging agents. Clonal cytopenia of undetermined significance (CCUS) is a precursor of de novo myeloid neoplasms. Characteristics of CCUS that develop following cytotoxic therapies (therapy-related clonal cytopenia, t-CC) and outcomes following t-CC have not been described. We identified 33 patients with t-CC and compared to a cohort of the WHO-defined t-MN (n = 309). t-CC had a distinct genetic and cytogenetic profile: pathogenic variants (PV) in TET2 and SRSF2 were enriched in t-CC, whereas TP53 PV was more common in t-MN. Ten (30%) t-CC patients developed a subsequent t-MN, with a cumulative incidence of 13%, 23%, and 50% at 6 months, 1, and 5 years, respectively. At t-MN progression, 44% of evaluable patients had identifiable clonal evolution. The median survival following t-CC was significantly superior compared all t-MN phenotype including t-MDS with <5% bone marrow blasts (124.5 vs. 16.3 months, P < 0.001) respectively. The presence of cytogenetic abnormality and the absence of variants in DNMT3A, TET2, or ASXL1 (DTA-genes) were associated with a higher likelihood of developing a subsequent t-MN and an inferior survival. We describe a putative precursor entity of t-MN with distinct features and outcomes.
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40
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Jeon M, Youn N, Kim S. What are the late effects of older gastric cancer survivors?: A scoping review. Asia Pac J Oncol Nurs 2022; 9:100113. [PMID: 36158706 PMCID: PMC9500514 DOI: 10.1016/j.apjon.2022.100113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Misun Jeon
- College of Nursing & Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Nayung Youn
- College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Sanghee Kim
- College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- Corresponding author.
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41
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Wang C, Shen Y, Zhang Y, Guo F, Li Q, Zhang H, Han X, Zhao H, Yang Z. Metachronous Multiple Primary Carcinoma With Acute Promyelocytic Leukemia: 2 Cases Report and Literature Review. Front Oncol 2022; 12:893319. [PMID: 35756676 PMCID: PMC9214198 DOI: 10.3389/fonc.2022.893319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
The co-occurrence of multiple primary cancers with hematological malignancies is uncommon, and acute promyelocytic leukemia (APL) with MPC is even rarer, with only a few cases reported in the literature. Herein, we introduce the diagnosis and treatment of 2 cases of MPC complicated with APL in our hospital and review the relevant literature. Both patients were primary solid tumor patients and were treated with surgery and chemotherapy, and had stable disease (SD). However, more than 1 year after the primary tumor was diagnosed, clinical symptoms were found and APL was diagnosed. Both patients received standard remission-induction therapy, but unfortunately died in the short term due to hemorrhagic complications. In conclusion, treatment of hematological neoplasms, especially acute leukemia combined with multiple primary cancers, is challenging. The prognostic factors and survival analysis of MPC patients with combined APL still need further clinical research and analysis.
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Affiliation(s)
- Cong Wang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Yamei Shen
- Wuwei Institute of Hematology, Wuwei, China
| | - Yuxia Zhang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Fahui Guo
- Wuwei Institute of Hematology, Wuwei, China
| | - Qian Li
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Huahua Zhang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
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Zhao Q, Ma P, Fu P, Wang J, Wang K, Chen L, Yang Y. Myelodysplastic Syndrome/Acute Myeloid Leukemia Following the Use of Poly-ADP Ribose Polymerase (PARP) Inhibitors: A Real-World Analysis of Postmarketing Surveillance Data. Front Pharmacol 2022; 13:912256. [PMID: 35784751 PMCID: PMC9240214 DOI: 10.3389/fphar.2022.912256] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: poly-ADP ribose polymerase (PARP) inhibitors show impressive efficacy in a range of tumors. However, concerns about rare and fatal adverse events, including myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML) have arisen. The aim of this study was to excavate and evaluate the risk of PARP inhibitors causing MDS and AML based on real-world data from two international pharmacovigilance databases. Methods: We analyzed adverse event (AE) reports of four PARP inhibitors (olaparib, niraparib, rucaparib and talazoparib) associated with MDS and AML from the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and EudraVigilance (EV) databases between 1 October 2014, and 30 September 2021, including demographic characteristics, fatality and times to onset. Three different data mining algorithms were used to detect the signals of PARP inhibitors associated with MDS and AML. Results: In total, 16,710 and 11,937 PARP inhibitor AE reports were found in the FAERS and EV databases, of which 332 and 349 were associated with MDS and AML, respectively. The median latencies of MDS and AML associated with PARP inhibitors were 211 [interquartile range (IQR) 93.5–491.25] days and 355 (IQR 72.00–483.50) days, respectively. The average fatality rates of MDS and AML caused by the four PARP inhibitors were 39.23 and 45.39%, respectively, in the FAERS database, while those in the EV database were 32.32 and 34.94%, respectively. Based on the criteria used for the three algorithms, a significant disproportionate association was found between PARP inhibitors as a drug class and MDS/AML. Notably, the risk of MDS was much higher than that of AML. Olaparib appeared to have a stronger association with MDS and AML than did other PARP inhibitors. Conclusion: In the real world, PARP inhibitors increase the risk of MDS and AML, which can result in high mortality and tend to occur during long-term use. Our findings provide objective evidence for the postmarketing safety of PARP inhibitors.
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Affiliation(s)
- Quanfeng Zhao
- Department of Pharmacy, The First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, China
| | - Pan Ma
- Department of Pharmacy, The First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, China
| | - Peishu Fu
- Department of Pharmacy, The First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, China
| | - Jiayu Wang
- Department of Pharmacy, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Kejing Wang
- Department of Pharmacy, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Kejing Wang, ; Lin Chen, ; Yang Yang,
| | - Lin Chen
- Department of Pharmacy, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Kejing Wang, ; Lin Chen, ; Yang Yang,
| | - Yang Yang
- Department of Pharmacy, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Kejing Wang, ; Lin Chen, ; Yang Yang,
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43
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Allogeneic hematopoietic cell transplantation in patients with therapy-related myeloid neoplasm after breast cancer: a study of the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2022; 57:1072-1078. [PMID: 35459878 DOI: 10.1038/s41409-022-01686-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/19/2022] [Accepted: 04/11/2022] [Indexed: 11/08/2022]
Abstract
We performed a registry study on therapy-related myeloid neoplasm (t-MN), both therapy-related myelodysplastic syndrome (t-MDS) and acute myeloid leukemia (t-AML) following treatment for breast cancer who underwent a first allogeneic hematopoietic cell transplant (allo-HCT). Of 252 identified female patients (median age 57 years), 77% were transplanted for t-AML and 23% for t-MDS, with a median time from breast cancer diagnosis to the diagnosis of tMN and subsequent allo-HCT of 3.7 and 4.6 years, respectively. At transplant, 191 patients were in remission for breast cancer, while 4 were not (57 missing). T-MN was in a complete remission at the time of transplant in 67% of patients. 2-year overall survival, relapse free-survival, relapse incidence and non-relapse mortality were 50%, 45%, 33%, and 22%, respectively. Multivariable analysis revealed that if the t-MN was not in CR pre-transplant, this was associated with lower OS, RFS, and a higher relapse incidence. Seventeen cases of breast cancer recurrence were recorded after a median of 2.4 years post-transplant, and relapse of primary breast cancer accounted for 7% of deaths. This study indicates that allo-HCT for t-MN following treatment for breast cancer shows encouraging transplant outcomes. The incidence of breast cancer relapse post-transplant remains a cause for concern.
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Yang J, Chen B. Therapy‑related acute myeloid leukemia: A case series. Oncol Lett 2022; 23:171. [PMID: 35497938 PMCID: PMC9019864 DOI: 10.3892/ol.2022.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with primary cancer receiving chemotherapy and/or radiotherapy may develop therapy-related acute leukemia (t-AL). Therapy-related acute myeloid leukemia (t-AML) accounts for the majority of these cases and is frequently associated with a variety of cytogenetic and molecular abnormalities. The aim of the present study was to explore the clinical characteristics, treatments and prognosis of patients with t-AML. A total of 272 cases of AML treated at our institution between 2016 and 2020 were reviewed, among which nine cases of t-AML were identified for analysis. All patients had received alkylating or topoisomerase II inhibitor chemotherapy drugs for primary cancer treatment and three patients had received radiotherapy. A total of nine patients had been administered recombinant human granulocyte colony-stimulating factor (G-CSF). The median latency period for the nine patients with t-AML was 25 months (range, 10–240 months). The molecular cytogenetic abnormalities included t(15:17)(q22:q21), inv(16)(p13q22), del(5)(q22), CBFB/MYH11(+), FLT3(+), NARS(+), IDH(+), TET2(+), and TP53(+). Out of nine patients with t-AML, eight received chemotherapy, two of whom underwent HSCT. The median survival time of the nine patients with t-AML was 10 months and the 2-year-survival rate was 44.4%. Greater clarity around the diagnosis and treatment is required to improve the outcomes of patients with t-AML.
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Affiliation(s)
- Jie Yang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
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45
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Claxton DF. Clonal haematopoiesis as a risk factor for therapy-related myeloid neoplasms in patients with chronic lymphocytic leukaemia treated with chemo-(immuno)therapy. Br J Haematol 2022; 198:9-10. [PMID: 35362550 DOI: 10.1111/bjh.18174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
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Risk of second primary neoplasms of the central nervous system. Adv Radiat Oncol 2022; 7:100969. [PMID: 35814854 PMCID: PMC9260125 DOI: 10.1016/j.adro.2022.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Second primary (SP) neoplasms of the central nervous system (CNS) among cancer survivors are devastating but poorly understood processes. The absolute risk, or true incidence, of developing an SP CNS tumor among cancer survivors is not well characterized. Methods and Materials Patients diagnosed with cancer between 1975 and 2016 were queried using the Surveillance, Epidemiology, and End Results Program. Cumulative incidence rates (CIRs) were estimated using competitive risk analysis. The effects of covariates were assessed using multivariate competitive risk regression. Results More than 3.8 million patient records were extracted. The absolute risk of developing an SP CNS neoplasm at 25 years was highest among long-term survivors of CNS cancers (CIR, 6.6%). Cranial radiation increased the incidence of SP tumors in pediatric patients (25-year CIR, 5.7% vs 1.1%; P = .0012) but not adults (25-year CIR, 5.8% vs 5.0%; P = .66). Multivariate cumulative risk regression identified radiation among pediatric patients as the greatest risk for an increased CIR (subdistribution hazard ratio, 2.50; 95% CI, 1.86-3.38; P = 2e-9). Meningiomas (42.9% vs 24.1%; P = 2e-7) and glioblastomas (20.5% vs 14.5%; P = .046) represented a greater proportion of the SP CNS tumors in those who received cranial irradiation. The median age of an SP diagnosis was decreased among those who received prior radiation (41 years [interquartile range (IQR), 30-65 years] vs 49 years [IQR, 30-65 years]; P = 7e-5). Conclusions The risk of developing a second primary CNS neoplasm is elevated in patients with a prior CNS cancer independent of treatment history. The association between cranial radiation therapy and risk for subsequent cancers may be limited to the pediatric population.
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Kerle IA, Jägerhuber L, Secci R, Pfarr N, Blüm P, Roesch R, Götze KS, Weichert W, Bassermann F, Ruland J, Winter C. Circulating Tumor DNA Profiling of a Diffuse Large B Cell Lymphoma Patient with Secondary Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14061371. [PMID: 35326522 PMCID: PMC8946858 DOI: 10.3390/cancers14061371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/01/2023] Open
Abstract
Diffuse large B cell lymphomas (DLBCL) are the most common neoplasia of the lymphatic system. Circulating cell-free DNA released from tumor cells (ctDNA) has been studied in many tumor entities and successfully used to monitor treatment and follow up. Studies of ctDNA in DLBCL so far have mainly focused on tracking mutations in peripheral blood initially detected by next-generation sequencing (NGS) of tumor tissue from one lymphoma manifestation site. This approach, however, cannot capture the mutational heterogeneity of different tumor sites in its entirety. In this case report, we present repetitive targeted next-generation sequencing combined with digital PCR out of peripheral blood of a patient with DLBCL relapse. By combining both detection methods, we were able to detect a new dominant clone of ctDNA correlating with the development of secondary therapy-related acute myeloid leukemia (t-AML) during the course of observation. Conclusively, our case report reinforces the diagnostic importance of ctDNA in DLBCL as well as the importance of repeated ctDNA sequencing combined with focused digital PCR assays to display the dynamic mutational landscape during the clinical course.
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Affiliation(s)
- Irina A. Kerle
- Department of Medicine III, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (I.A.K.); (P.B.); (K.S.G.); (F.B.)
- Center for Personalized Oncology, National Center for Tumor Diseases (NCT) Dresden and University Hospital Carl Gustav Carus Dresden at TU Dresden, 01307 Dresden, Germany
| | - Ludwig Jägerhuber
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (L.J.); (R.S.); (R.R.); (J.R.)
| | - Ramona Secci
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (L.J.); (R.S.); (R.R.); (J.R.)
| | - Nicole Pfarr
- Institute of Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (N.P.); (W.W.)
| | - Philipp Blüm
- Department of Medicine III, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (I.A.K.); (P.B.); (K.S.G.); (F.B.)
| | - Romina Roesch
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (L.J.); (R.S.); (R.R.); (J.R.)
| | - Katharina S. Götze
- Department of Medicine III, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (I.A.K.); (P.B.); (K.S.G.); (F.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (N.P.); (W.W.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Florian Bassermann
- Department of Medicine III, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (I.A.K.); (P.B.); (K.S.G.); (F.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, 81675 Munich, Germany
| | - Jürgen Ruland
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (L.J.); (R.S.); (R.R.); (J.R.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, 81675 Munich, Germany
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (L.J.); (R.S.); (R.R.); (J.R.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, 81675 Munich, Germany
- Correspondence:
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Yang Z, Liu X, Yang X, Liao QP. Second primary malignancies after ovarian cancer: A SEER-based analysis (1975-2016). Taiwan J Obstet Gynecol 2022; 61:80-85. [PMID: 35181052 DOI: 10.1016/j.tjog.2021.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate the risk of occurrence of second primary malignancies (SPMs) in survivors of ovarian cancer (OC) using large data from the Surveillance, Epidemiology, and End Results (SEER) database. MATERIALS AND METHODS Multiple primaries standardized incidence ratios (MP-SIRs) to calculate the risk of developing second primary malignancies after a diagnosis of ovarian cancer. RESULTS Of our included 59,880 women with OC, 3972 cases (6.6%) developed 4495 s primary malignancies over an average follow-up period of 114.39 (±102.66) months. Overall, the risk of occurrence of second primary malignancies after a diagnosis of OC was greater than what would be expected for a reference US population (SIR = 1.05, 95%CI = 1.02-1.08, p-value < 0.05). The occurrence of second myeloid malignancies and second thyroid cancer were most notable across our latency periods. Among the most significant second primary malignancies by latency were malignancies of the appendix (SIR = 14.04, 95%CI = 5.65-28.93, p-value <0.05) at 2-11 months, the small intestine (SIR = 3.15, 95%CI = 1.76-5.2, p-value <0.05) at 12-59 months, and the urinary bladder (SIR = 1.63, 95%CI = 1.3-2.02, p-value <0.05) after 10 years of an OC diagnosis. CONCLUSION Women with OC are at significant risk for the development of second primary malignancies across all sites, as compared to a reference US population, and may benefit from second primary malignancies site-specific screening post-diagnosis.
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Affiliation(s)
- Zihui Yang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
| | - Xinyu Liu
- Department of Reproductive Medicine, Shenyang 204 Hospital, Liaoning, 110000, China.
| | - Xi Yang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
| | - Qin-Ping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
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Martorana F, Da Silva LA, Sessa C, Colombo I. Everything Comes with a Price: The Toxicity Profile of DNA-Damage Response Targeting Agents. Cancers (Basel) 2022; 14:cancers14040953. [PMID: 35205700 PMCID: PMC8870347 DOI: 10.3390/cancers14040953] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary DNA damage induces genome instability, which may elicit cancer development. Defects in the DNA repair machinery further enhance cancer predisposition, but can also be exploited as a therapeutic target. Indeed, targeted agents against specific components of DNA repair, such as PARP inhibitors, are employed in various tumor types, while others, such as ATR, CHK1 or WEE1 inhibitors, are in clinical development. Even though these molecules have proven to be effective in different settings, they display several on- and off-target toxicities, shared by the whole pharmacological class or are drug specific. Among these effects, hematological and gastrointestinal toxicities are the most common, while others are less frequent but potentially life-threatening (e.g., myelodysplastic syndromes). Particular caution is needed in the case of combinatorial therapeutic approaches, which are currently being developed in clinical trials. In any case, it is necessary to recognize and properly manage adverse events of these drugs. This review provides a comprehensive overview on the safety profile of DDR-targeting agents, including indications for their management in clinical practice. Abstract Targeting the inherent vulnerability of cancer cells with an impaired DNA Damage Repair (DDR) machinery, Poly-ADP-Ribose-Polymerase (PARP) inhibitors have yielded significant results in several tumor types, eventually entering clinical practice for the treatment of ovarian, breast, pancreatic and prostate cancer. More recently, inhibitors of other key components of DNA repair, such as ATR, CHK1 and WEE1, have been developed and are currently under investigation in clinical trials. The inhibition of DDR inevitably induces on-target and off-target adverse events. Hematological and gastrointestinal toxicities as well as fatigue are common with all DDR-targeting agents, while other adverse events are drug specific, such as hypertension with niraparib and transaminase elevation with rucaparib. Cases of pneumonitis and secondary hematological malignancies have been reported with PARP inhibitors and, despite being overly rare, they deserve particular attention due to their severity. Safety also represents a crucial issue for the development of combination regimens incorporating DDR-targeting agents with other treatments, such as chemotherapy, anti-angiogenics or immunotherapy. As such, overlapping and cumulative toxicities should be considered, especially when more than two classes of drugs are combined. Here, we review the safety profile of DDR-targeting agents when used as single agents or in combination and we provide principles of toxicity management.
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Affiliation(s)
- Federica Martorana
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Leandro Apolinario Da Silva
- Service of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (L.A.D.S.); (C.S.)
| | - Cristiana Sessa
- Service of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (L.A.D.S.); (C.S.)
| | - Ilaria Colombo
- Service of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (L.A.D.S.); (C.S.)
- Correspondence: ; Tel.: +41-91-811-8194
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Vo JB, Ramin C, Barac A, Berrington de Gonzalez A, Veiga L. Trends in heart disease mortality among breast cancer survivors in the US, 1975-2017. Breast Cancer Res Treat 2022; 192:611-622. [PMID: 35107712 PMCID: PMC8960573 DOI: 10.1007/s10549-022-06515-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
Purpose Heart disease is a significant concern among breast cancer survivors, in part due to cardiotoxic treatments including chemotherapy and radiotherapy. Long-term trends in heart disease mortality have not been well characterized. We examined heart disease mortality trends among US breast cancer survivors by treatment type. Methods We included first primary invasive breast cancer survivors diagnosed between 1975 and 2016 (aged 18–84; survived 12 + months; received initial chemotherapy, radiotherapy, or surgery) in the SEER-9 Database. Standardized mortality ratios (SMRs) and 10-year cumulative heart disease mortality estimates accounting for competing events were calculated by calendar year of diagnosis and initial treatment regimen. Ptrends were assessed using Poisson regression. All statistical tests were 2-sided. Results Of 516,916 breast cancer survivors, 40,812 died of heart disease through 2017. Heart disease SMRs declined overall from 1975–1979 to 2010–2016 (SMR 1.01 [95%CI: 0.98, 1.03] to 0.74 [0.69, 0.79], ptrend < 0.001). This decline was also observed for survivors treated with radiotherapy alone and chemotherapy plus radiotherapy. A sharper decline in heart disease SMRs was observed from 1975 to 1989 for left-sided radiotherapy, compared to right-sided. In contrast, there was a non-significant increasing trend in SMRs for chemotherapy alone, and significant by regional stage (ptrend = 0.036). Largest declines in 10-year cumulative mortality were observed from 1975–1984 to 2005–2016 among surgery only: 7.02% (95%CI: 6.80%, 7.23%) to 4.68% (95%CI: 4.39%, 4.99%) and radiotherapy alone: 6.35% (95%CI: 5.95%, 6.77%) to 2.94% (95%CI: 2.73%, 3.16%). Conclusions We observed declining heart disease mortality trends by most treatment types yet increasing for regional stage patients treated with chemotherapy alone, highlighting a need for additional studies with detailed treatment data and cardiovascular management throughout cancer survivorship. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06515-5.
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Affiliation(s)
- Jacqueline B Vo
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. .,Cancer Prevention Fellowship Program, Division of Cancer Prevention, Bethesda, MD, USA.
| | - Cody Ramin
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ana Barac
- Director of Cardio-Oncology and Professor of Medicine, Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lene Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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