Chemotherapy for Solid Tumors Associated With Increased Risk of AML, MDS

Laura Joszt

Patients who are treated with chemotherapy for their solid tumors have an increased risk of therapy-related myelodysplastic syndrome and acute myeloid leukemia (tMDS/AML) despite advances in chemotherapy regimens, according to a new study in JAMA Oncology.1

The study analyzed 700,612 adults in a US cancer data registry. Patients were between the ages of 20 and 84 years and had their first primary solid cancer diagnosed between 2000 and 2013, and they survived 1 year or longer. One year after the primary diagnosis, patients were followed until second cancer diagnosis, death, age 85, loss of follow-up, or the end of the study.

“Although the absolute risk of developing tMDS/AML is low, its treatment is often resource intensive and associated with substantial morbidity; overall survival is poor, highlighting its clinical significance,” the authors explained.

Among the 700,612 adults analyzed, there were 1619 cases of tMDS/AML and the researchers found elevated risks of tMDS/AML for all 22 cancers. The risks were highest after chemotherapy for bone, soft tissue, and testis cancers. Therapy-related MDS/AML risks were not elevated in patients treated with chemotherapy for colon cancer.

According to the authors, this study is the first to provide clear evidence that chemotherapy for oral cavity or pharynx, esophagus, stomach, rectum, larynx, bone, cervix, uterine corpus, and vagina or vulva cancers is associated with an risk of tMDS/AML.

In an accompany editorial,2 Shyam A. Patel, MD, PhD, of the Stanford Cancer Institute at Stanford University School of Medicine, highlighted the study’s finding that treatment with chemotherapy at a young age actually posed the highest relative risk.

He added that the study raises the question of how to perform a risk assessment of chemotherapy used to treat solid tumors.

“Future efforts should be focused specifically on patients who are at highest risk of tMDS/AML. It is critical that risk assessment models for tMDS/AML consider the clonal evolution of subclinical mutations into overt, clinically apparent disease,” he concluded.

1. Morton LM, Dores GM, Schonfeld SJ, et al. Association of chemotherapy for solid tumors with development of therapy-related myelodysplastic syndrome or acute myeloid leukemia in the modern era. [published online December 20, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2018.5625.
2. Patel SA. Myelodysplastic syndrome and acute myeloid leukemiar risk associated with solid tumor chemotherapy. [published online December 20, 2018]. JAMA Oncol.  doi:10.1001/jamaoncol.2018.5617.
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