Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Wolff AC

PROVIDER: S-EPMC4302215 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Publications

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

Wolff Antonio C AC Blackford Amanda L AL Visvanathan Kala K Rugo Hope S HS Moy Beverly B Goldstein Lori J LJ Stockerl-Goldstein Keith K Neumayer Leigh L Langbaum Terry S TS Theriault Richard L RL Hughes Melissa E ME Weeks Jane C JC Karp Judith E JE

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20141222 4

<h4>Purpose</h4>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).<h4>Patients and methods</h4>We examined the MN frequency in 20,063 patients with stage I to III breast cancer treated at US academic centers between 1998 and ...[more]

PMID: 25534386

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Dataset Information

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

Purpose

Patients and methods

Results

Conclusion

Publications

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

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