title: Risks of Venous Thromboembolism, Stroke, Heart Disease, and Myelodysplastic Syndrome Associated With Hematopoietic Growth Factors in a Large Population-Based Cohort of Patients With Colorectal Cancer.
abstract: OBJECTIVE
  To determine the relationship between the receipt of colony-stimulating factors (CSFs) with erythropoiesis-stimulating agents (ESAs) and the risk of developing venous thromboembolism (VTE), stroke, heart disease, and myelodysplastic syndrome (MDS) in patients with colorectal cancer.
  
  
  METHODS
  We studied 80,925 patients diagnosed with colorectal cancer at age ≥ 65 years in 1992-2009 from the nationwide 16 areas of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Cumulative incidence and the time to events Cox hazard regressions were used to explore the risks of outcomes in association with the receipt of CSFs and ESAs.
  
  
  RESULTS
  Patients who received chemotherapy (CT) with both CSF and ESA were 58% more likely to develop VTE than those who received CT without CSF and ESA (hazard ratio, 1.58; 95% confidence interval, 1.43-1.76). The risk of stroke appeared to be not associated with the use of CSF and ESA, whereas the risk of heart disease was only significantly elevated in those patients who did not receive CT but received ESA. The risk of acute myeloid leukemia or MDS was significantly increased 4- to 9-fold in patients who received ESA, regardless of receipt of CT or CSF.
  
  
  CONCLUSIONS
  The use of ESAs was significantly associated with a substantially increased risk of MDS in patients with colorectal cancer. The use of CSFs and ESAs was also significantly associated with a moderately increased risk of VTE and a slightly elevated risk of heart disease.
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Center for Health Services Research, University of Texas School of Public Health, Houston, TX. Electronic address: Xianglin.L.Du@uth.tmc.edu.
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Department of Biostatistics, University of Texas School of Public Health, Houston, TX.
authors.forename: Yefei
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003115:Colony-Stimulating Factors / Q000009:adverse effects / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006397:Hematinics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000453:epidemiology; D012306:Risk; D018426:SEER Program; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors; D006397:Hematinics
keywords: Acute leukemia; Colorectal cancer; Heart disease; Hematopoietic growth factor; Thromboembolism