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 |
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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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