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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.
- Source :
-
Cancer [Cancer] 2008 Apr 01; Vol. 112 (7), pp. 1513-21. - Publication Year :
- 2008
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Chemotherapy, Adjuvant
Cohort Studies
Female
Follow-Up Studies
Humans
Leukemia, Myeloid, Acute pathology
Leukemia, Myeloid, Acute therapy
Male
Middle Aged
Myelodysplastic Syndromes pathology
Myelodysplastic Syndromes therapy
Neoplasm Invasiveness
Neoplasms drug therapy
Neoplasms radiotherapy
Neoplasms surgery
Neoplasms, Second Primary pathology
Neoplasms, Second Primary therapy
Phenotype
Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
Prognosis
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Leukemia, Myeloid, Acute etiology
Myelodysplastic Syndromes etiology
Neoplasms therapy
Neoplasms, Second Primary etiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma etiology
Subjects
Details
- Language :
- English
- ISSN :
- 0008-543X
- Volume :
- 112
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 18286528
- Full Text :
- https://doi.org/10.1002/cncr.23325