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Chemotherapy did not increase risk for AML, MDS in early breast cancer

Adjuvant chemotherapy for early breast cancer did not increase the risk for acute myeloid leukemia and myelodysplastic syndrome, according to results of a retrospective study.

Incidence rates of AML and myelodysplastic syndrome (MDS) in large populations of patients with breast cancer who receive pegfilgrastim (Neulasta, Amgen) or newer adjuvant regimens are not widely characterized, according to researchers.

Neelima Denduluri, MD, medical oncologist and hematologist at the Virginia Cancer Specialists, and colleagues used iKnowMed — an electronic health record from a large network of community oncology practices — to extract data about patients diagnosed with stage I to stage III breast cancer from 2007 to 2010.

All patients had at least five visits. Median follow-up was 2.8 years (range, 1.2-5.2 years).

Denduluri and colleagues identified 20,900 eligible patients; of them, 11,295 (54%) received chemotherapy and 9,605 (46%) did not. The median age of patients who received chemotherapy was 54 years. The median age for patients in the non-chemotherapy arm was 64 years (P<.01).

Among those treated with chemotherapy, 12 patients (0.11%) developed AML/MDS (95% CI, 0.06-0.19), with median time to onset of 1.8 years. Of those 12 patients, eight received anthracyclines and 11 received pegfilgrastim.

Among patients who did not undergo chemotherapy, 16 (0.19%) developed AML/MDS (95% CI, 0.11-0.3), with median time to onset of 2.2 years.

The low event rate in the study population may be due to short follow-up, younger age in the chemotherapy treated arm and/or high use of non-anthracycline chemotherapy, Denduluri said.

Multivariate analysis of patients who received chemotherapy showed patients aged 70 years or older were more likely to develop AML and MDS (HR=7.06; P<.01).

Those who received anthracyclines-containing chemotherapy were more likely to develop AML and MDS compared with those who received alternate regimens (HR=3.89; P=.04).

Reference:
Denduluri N. Abstract #62.
Disclosure:

Denduluri reports no relevant 
financial disclosures.

Adjuvant chemotherapy for early breast cancer did not increase the risk for acute myeloid leukemia and myelodysplastic syndrome, according to results of a retrospective study.

Incidence rates of AML and myelodysplastic syndrome (MDS) in large populations of patients with breast cancer who receive pegfilgrastim (Neulasta, Amgen) or newer adjuvant regimens are not widely characterized, according to researchers.

Neelima Denduluri, MD, medical oncologist and hematologist at the Virginia Cancer Specialists, and colleagues used iKnowMed — an electronic health record from a large network of community oncology practices — to extract data about patients diagnosed with stage I to stage III breast cancer from 2007 to 2010.

All patients had at least five visits. Median follow-up was 2.8 years (range, 1.2-5.2 years).

Denduluri and colleagues identified 20,900 eligible patients; of them, 11,295 (54%) received chemotherapy and 9,605 (46%) did not. The median age of patients who received chemotherapy was 54 years. The median age for patients in the non-chemotherapy arm was 64 years (P<.01).

Among those treated with chemotherapy, 12 patients (0.11%) developed AML/MDS (95% CI, 0.06-0.19), with median time to onset of 1.8 years. Of those 12 patients, eight received anthracyclines and 11 received pegfilgrastim.

Among patients who did not undergo chemotherapy, 16 (0.19%) developed AML/MDS (95% CI, 0.11-0.3), with median time to onset of 2.2 years.

The low event rate in the study population may be due to short follow-up, younger age in the chemotherapy treated arm and/or high use of non-anthracycline chemotherapy, Denduluri said.

Multivariate analysis of patients who received chemotherapy showed patients aged 70 years or older were more likely to develop AML and MDS (HR=7.06; P<.01).

Those who received anthracyclines-containing chemotherapy were more likely to develop AML and MDS compared with those who received alternate regimens (HR=3.89; P=.04).

Reference:
Denduluri N. Abstract #62.
Disclosure:

Denduluri reports no relevant 
financial disclosures.

    Perspective
    Kathy S. Albain MD

    Kathy S. Albain MD

    This topic has been in the news recently due to a high-profile patient, television broadcaster Robin Roberts, going public about her diagnosis with MDS following breast cancer treatment. What this presentation has done is looked at a very large oncology network practice group and produced rates of leukemia or myelodysplastic syndrome, which sometimes precedes leukemia. The rates were similar in the two groups and were lower than what sometimes is reported. The caveat to this is that, although the results are reassuring, the follow-ups are not complete. It is still early for secondary leukemia, which can occur as late as 5 years. This study provides some real good data and a benchmark to quote to patients. Every patient who undergoes chemotherapy that includes these drugs needs to be told upfront about the possibility of this rare event.

    • Kathy S. Albain MD
    • Professor of medicine Department of hematology/oncology Loyola University Health System

    Disclosures: Albain reports no relevant financial disclosures.

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