title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Arwa
authors.initials: A
authors.lastname: Abdelhameed
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.forename: Joseph
authors.initials: J
authors.lastname: Brandwein
authors.forename: Kathy
authors.initials: K
authors.lastname: Chun
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kamel-Reid
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lipton
authors.forename: Mark D
authors.initials: MD
authors.lastname: Minden
authors.forename: Aaron
authors.initials: A
authors.lastname: Schimmer
authors.forename: Andre
authors.initials: A
authors.lastname: Schuh
authors.forename: Karen
authors.initials: K
authors.lastname: Yee
authors.forename: Hans A
authors.initials: HA
authors.lastname: Messner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D009361:Neoplasm Invasiveness; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D010641:Phenotype; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome