Use of white blood cell growth factors and risk of acute myeloid leukemia or myelodysplastic syndrome among elderly patients with non-Hodgkin lymphoma

Authors

  • Stephen K. Gruschkus PhD,

    1. Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, Texas
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  • David Lairson PhD,

    1. Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas
    2. Center for Health Service Research, University of Texas School of Public Health, Houston, Texas
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  • J. Kay Dunn PhD,

    1. Division of Biostatistics, University of Texas School of Public Health, Houston, Texas
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  • Jan Risser PhD,

    1. Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, Texas
    2. Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas
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  • Xianglin L. Du MD, PhD

    Corresponding author
    1. Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, Texas
    2. Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas
    3. Center for Health Service Research, University of Texas School of Public Health, Houston, Texas
    • Division of Epidemiology and Disease Control, University of Texas School of Public Health, 1200 Herman Pressler Drive, RAS-E631, Houston, TX 77030
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    • Fax: (713) 500-9264


Abstract

BACKGROUND.

The current study was conducted to evaluate the association between colony-stimulating factor (CSF) use and the risk of developing therapy-related myelodysplastic syndromes or acute myeloid leukemia (t-MDS/AML) among a large cohort of elderly patients with non-Hodgkin lymphoma (NHL) who were treated with chemotherapy.

METHODS.

A total of 13,203 NHL patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed from 1992 through 2002. Patients were followed from their initial chemotherapy date until the date they were diagnosed with t-MDS/AML, death, or last follow-up (October 31, 2006), whichever occurred first.

RESULTS.

Overall, 40% (n = 5266) of patients received CSF. During the follow-up period (median follow-up, 2.9 years [range, 1-14.7 years]), 272 (5.2%) patients who were treated with CSF developed t-MDS/AML, compared with 230 (2.9%) patients who did not (P < .0001, log-rank test). The 5-year incidence of t-MDS/AML for patients receiving CSF was 14.1 per 1000 person-years compared with 8.3 per 1000 person-years for patients not receiving CSF. In a multivariable Cox regression analysis adjusted for gender, histology, stage, comorbidities, radiotherapy, and chemotherapy agent, CSF use was found to be independently associated with a 53% increased risk of t-MDS/AML (hazard ratio [HR], 1.53; 95% confidence interval [95% CI], 1.26-1.84). The observed association between CSF use and t-MDS/AML persisted across histologic subgroups (ie, diffuse large B-cell lymphoma, follicular lymphoma, and others). Patients who received both CSF and antimetabolite chemotherapy were found to have a 2.5-fold increased risk of t-MDS/AML (HR, 2.49; 95% CI, 1.91-3.26) compared with patients who received neither agent.

CONCLUSIONS.

The current study, which to our knowledge is the first large population-based study published to date, demonstrated that the administration of CSF among elderly NHL patients receiving chemotherapy was associated with an increased risk of t-MDS/AML, although the absolute risk was low. Cancer 2010. © 2010 American Cancer Society.

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