Abstract
Existing data suggest that myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) peak in incidence 5-10 years following exposure to ionizing radiation, while most publications report less than 5 years of follow-up after radioimmunotherapy (RIT). We report the rate of secondary MDS/AML among 60 patients treated with two front-line sequential chemotherapy-RIT trials with over 11 years of follow-up. Among 35 patients evaluated after fludarabine-RIT and 25 patients evaluated after CVP (cyclophosphamide, vincristine, prednisone)-RIT treatment, the crude, cumulative and Kaplan-Meier rates of MDS/AML at 11 years of follow-up from the combined trials were 0.12/person, 0.010/person-year and 14% (95% confidence interval [CI] 5-24%), respectively. Additionally, we found that patients treated with RIT consolidation appear to have durable remissions but that relapses after 10 years do occur. Studies of efficacy and secondary MDS/AML that report fewer than 10 years of follow-up likely underestimate risk.
Keywords:
Radioimmunotherapy; acute myeloid leukemia; follicular lymphoma; myelodysplastic syndrome.
Publication types
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Aged
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Aged, 80 and over
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Biopsy
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Bone Marrow / pathology
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Clinical Trials, Phase II as Topic
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Clinical Trials, Phase III as Topic
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Consolidation Chemotherapy
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Female
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Follow-Up Studies
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Humans
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Induction Chemotherapy
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Kaplan-Meier Estimate
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Leukemia, Myeloid, Acute / diagnosis
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Leukemia, Myeloid, Acute / epidemiology
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Leukemia, Myeloid, Acute / etiology
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Leukemia, Myeloid, Acute / mortality
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Lymphoma / diagnosis
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Lymphoma / epidemiology*
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Lymphoma / mortality
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Lymphoma / therapy*
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Male
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Middle Aged
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Myelodysplastic Syndromes / diagnosis
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Myelodysplastic Syndromes / epidemiology
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Myelodysplastic Syndromes / etiology
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Myelodysplastic Syndromes / mortality
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Neoplasms, Second Primary / diagnosis
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Neoplasms, Second Primary / epidemiology*
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Neoplasms, Second Primary / etiology*
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Neoplasms, Second Primary / mortality
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Radioimmunotherapy* / adverse effects
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Radioimmunotherapy* / methods
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Recurrence
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Tomography, X-Ray Computed
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Treatment Outcome