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Outcome of patients who develop acute leukemia or myelodysplasia as a second malignancy after solid tumors treated surgically or with strategies that include chemotherapy and/or radiation
Article first published online: 19 FEB 2008
Copyright © 2008 American Cancer Society
Volume 112, Issue 7, pages 1513–1521, 1 April 2008
How to Cite
Abdelhameed, A., Pond, G. R., Mitsakakis, N., Brandwein, J., Chun, K., Gupta, V., Kamel-Reid, S., Lipton, J. H., Minden, M. D., Schimmer, A., Schuh, A., Yee, K. and Messner, H. A. (2008), Outcome of patients who develop acute leukemia or myelodysplasia as a second malignancy after solid tumors treated surgically or with strategies that include chemotherapy and/or radiation. Cancer, 112: 1513–1521. doi: 10.1002/cncr.23325
- Issue published online: 19 MAR 2008
- Article first published online: 19 FEB 2008
- Manuscript Accepted: 26 OCT 2007
- Manuscript Revised: 18 SEP 2007
- Manuscript Received: 17 JUL 2007
- primary solid tumors;
- acute leukemia;
- blood and marrow transplants;
- treatment-related mortality
Evaluation of therapeutic outcomes and risk factors was undertaken for patients with primary solid tumors (PST) developing acute leukemia or myelodysplasia (MDS) as a second malignancy.
In all, 131 consecutive patients presenting to a single institution with leukemia or MDS after treatment for PST with surgery or chemotherapy/radiotherapy were examined. Management of the secondary acute leukemia and MDS consisted either of intensive therapy including allogeneic blood and marrow transplants or supportive measures.
The time from diagnosis of PST to development of acute leukemia or MDS, the cytogenetic profile of patients, and their survival were similar irrespective of PST therapy with surgery alone or strategies involving chemotherapy and/or radiation. The median survival of all 131 patients was 10.5 months with a 5-year survival of 15.6%. Induction therapy and/or transplantation resulted in a median survival of 13.6 months and a 5-year survival of 26.6% compared with 6.5 months and 2% with supportive measures. Subset analysis of transplant recipients revealed a median survival of 17.6 months and a 37.9% 5-year survival. Despite a significantly lower recurrence rate the survival of transplant recipients was not improved secondary to a higher treatment-related mortality (TRM) rate.
Patients developing acute leukemia or MDS after PST demonstrated similar cytogenetic profiles and clinical outcomes independent of the type of treatment. Survival was significantly better for patients able to undergo intensive therapy compared with supportive measures. The low recurrence rate for allograft recipients was consistent with a potent antileukemic effect that may translate into a survival benefit if TRM could be reduced. Cancer 2008. © 2008 American Cancer Society.