Risk of marrow neoplasms after adjuvant breast cancer therapy: the national comprehensive cancer network experience

Autor: Leigh Neumayer, Kala Visvanathan, Melissa E. Hughes, Keith Stockerl-Goldstein, Beverly Moy, Hope S. Rugo, Jane C. Weeks, Amanda L. Blackford, R. L. Theriault, Lori J. Goldstein, Judith E. Karp, Terry S. Langbaum, Antonio C. Wolff
Rok vydání: 2014
Předmět:
Oncology
Cancer Research
Outcome Assessment
Databases
Factual
medicine.medical_treatment
Cohort Studies
Risk Factors
Epidemiology of cancer
Antineoplastic Combined Chemotherapy Protocols
Outcome Assessment
Health Care
80 and over
Cumulative incidence
Mastectomy
Cancer
Aged
80 and over
Incidence
Hematology
ORIGINAL REPORTS
Middle Aged
Leukemia
6.1 Pharmaceuticals
Bone marrow neoplasm
Female
Patient Safety
Erratum
Adult
medicine.medical_specialty
Adolescent
Clinical Sciences
Oncology and Carcinogenesis
Breast Neoplasms
Databases
Young Adult
Breast cancer
Clinical Research
Internal medicine
Breast Cancer
medicine
Humans
Oncology & Carcinogenesis
Factual
Aged
Neoplasm Staging
Radiotherapy
business.industry
Prevention
Evaluation of treatments and therapeutic interventions
medicine.disease
Survival Analysis
United States
Surgery
Health Care
Radiation therapy
business
Bone Marrow Neoplasms
Follow-Up Studies
SEER Program
Zdroj: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 33, iss 4
ISSN: 1527-7755
Popis: Purpose Outcomes for early-stage breast cancer have improved. First-generation adjuvant chemotherapy trials reported a 0.27% 8-year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia. Incomplete ascertainment and follow-up may have underestimated subsequent risk of treatment-associated marrow neoplasm (MN). Patients and Methods We examined the MN frequency in 20,063 patients with stage I to III breast cancer treated at US academic centers between 1998 and 2007. Time-to-event analyses were censored at first date of new cancer event, last contact date, or death and considered competing risks. Cumulative incidence, hazard ratios (HRs), and comparisons with Surveillance, Epidemiology, and End Results estimates were obtained. Marrow cytogenetics data were reviewed. Results Fifty patients developed MN (myeloid, n = 42; lymphoid, n = 8) after breast cancer (median follow-up, 5.1 years). Patients who developed MN had similar breast cancer stage distribution, race, and chemotherapy exposure but were older compared with patients who did not develop MN (median age, 59.1 v 53.9 years, respectively; P = .03). Two thirds of patients had complex MN cytogenetics. Risk of MN was significantly increased after surgery plus chemotherapy (HR, 6.8; 95% CI, 1.3 to 36.1) or after all modalities (surgery, chemotherapy, and radiation; HR, 7.6; 95% CI, 1.6 to 35.8), compared with no treatment with chemotherapy. MN rates per 1,000 person-years were 0.16 (surgery), 0.43 (plus radiation), 0.46 (plus chemotherapy), and 0.54 (all three modalities). Cumulative incidence of MN doubled between years 5 and 10 (0.24% to 0.48%); 9% of patients were alive at 10 years. Conclusion In this large early-stage breast cancer cohort, MN risk after radiation and/or adjuvant chemotherapy was low but higher than previously described. Risk continued to increase beyond 5 years. Individual risk of MN must be balanced against the absolute survival benefit of adjuvant chemotherapy.
Databáze: OpenAIRE
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