title: Characteristics and outcome of therapy-related myeloid neoplasms: Report from the Italian network on secondary leukemias.
abstract: Therapy-related myeloid neoplasms (t-MN) are a complication of cytotoxic treatment for primary tumors and autoimmune diseases. We report data on 277 t-MN patients, recruited between 1999 and 2013 by the Italian Network on Secondary Leukemias (104 retrospectively and 173 prospectively registered). Median age at t-MN diagnosis was 64 years (range, 21-87). Most frequent primary malignancies (PMs) were lymphoproliferative diseases and breast cancer. One hundred and thirty-three patients had received chemotherapy (CHT), 43 patients radiotherapy (RT), and 101 patients combined CHT/RT for PM. Median time between cytotoxic treatment and t-MN was 5.7 years, with t-MN following RT alone associated with significantly longer latency, compared to CHT or combined CHT/RT (mean, 11.2 vs. 7.1 years, P = 0.0005). The addition of topoisomerase-II inhibitors to alkylating agents was associated with shorter latency compared to alkylating agents alone (median, 6 vs. 8.4 years, P = 0.02). Median survival was 14.6 months from t-MN diagnosis, and was significantly longer in patients treated with allogeneic stem cell transplantation. Significant factors for survival at the multivariable analysis included age, adverse karyotype, and degree of anemia. Our data underline the prognostic importance of karyotype and age in t-MN, similar to de novo acute myeloid leukemia. Treatment approaches should not preclude the use of conventional treatments for younger t-MN patients, including allogeneic stem cell transplantation as potentially curative approach.
authors: Department of Hematology, Università Cattolica Sacro Cuore Roma, Roma, Italy.
authors: Luana
authors: L
authors: Fianchi
authors: Livio
authors: L
authors: Pagano
authors: Alfonso
authors: A
authors: Piciocchi
authors: Anna
authors: A
authors: Candoni
authors: Gianluca
authors: G
authors: Gaidano
authors: Massimo
authors: M
authors: Breccia
authors: Marianna
authors: M
authors: Criscuolo
authors: Giorgina
authors: G
authors: Specchia
authors: Enrico
authors: E
authors: Maria Pogliani
authors: Luca
authors: L
authors: Maurillo
authors: Maria Antonietta
authors: MA
authors: Aloe-Spiriti
authors: Cristina
authors: C
authors: Mecucci
authors: Pasquale
authors: P
authors: Niscola
authors: Elena
authors: E
authors: Rossetti
authors: Giovanna
authors: G
authors: Mansueto
authors: Michela
authors: M
authors: Rondoni
authors: Claudio
authors: C
authors: Fozza
authors: Rosangela
authors: R
authors: Invernizzi
authors: Antonio
authors: A
authors: Spadea
authors: Susanna
authors: S
authors: Fenu
authors: Gabriele
authors: G
authors: Buda
authors: Marco
authors: M
authors: Gobbi
authors: Emiliano
authors: E
authors: Fabiani
authors: Simona
authors: S
authors: Sica
authors: Stefan
authors: S
authors: Hohaus
authors: Giuseppe
authors: G
authors: Leone
authors: Maria Teresa
authors: MT
authors: Voso
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D005720:Gamma Rays / Q000009:adverse effects*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D059785:Karyotype; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D059003:Topoisomerase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D014184:Transplantation, Homologous
chemical_list: D018906:Antineoplastic Agents, Alkylating; D059003:Topoisomerase Inhibitors