Therapy-related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy

Ji Won Lee; Hoonji Oh; Ji Young You; Eun-Shin Lee; Jung Hyun Lee; Sung Eun Song; Nam Kwon Lee; Seung Pil Jung; Jung Seok An; Kyu Ran Cho; Cheol Yong Kim; Kyong Hwa Park

doi:10.1016/j.ejca.2023.112952

Therapy-related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy

Eur J Cancer. 2023 Sep:191:112952. doi: 10.1016/j.ejca.2023.112952. Epub 2023 Jun 22.

Authors

Ji Won Lee¹, Hoonji Oh², Ji Young You³, Eun-Shin Lee³, Jung Hyun Lee⁴, Sung Eun Song⁵, Nam Kwon Lee⁶, Seung Pil Jung³, Jung Seok An⁴, Kyu Ran Cho⁵, Cheol Yong Kim⁶, Kyong Hwa Park⁷

Affiliations

¹ Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea.
² Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea.
³ Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea.
⁴ Department of Pathology, Korea University Anam Hospital, Seoul, South Korea.
⁵ Department of Radiology, Korea University Anam Hospital, Seoul, South Korea.
⁶ Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea.
⁷ Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea. Electronic address: khpark@korea.ac.kr.

PMID: 37473463
DOI: 10.1016/j.ejca.2023.112952

Abstract

Background: Long-term complications are becoming more important as the survival rate of breast cancer improves. Treatment-related myeloid neoplasm is an important long-term complication in breast cancer survivors as it has a poor prognosis.

Objective: We evaluated the incidence and risk factors for the development of treatment-related acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) in patients treated with early breast cancer.

Methods: We accessed the national Korean database to identify 153,565 patients diagnosed with breast cancer between January 2007 and October 2016 who underwent surgery for breast cancer. We estimated the cumulative incidence of AML/MDS and analysed the risk factors for developing AML/MDS.

Results: Of 153,575 patients, 79,321 received anthracycline-based adjuvant therapy, 14,317 received adjuvant therapy without anthracyclines and 46,657 did not receive adjuvant chemotherapy. Overall, 120 developed AML (105 in the anthracycline group, 9 in the non-anthracycline group and 6 in the control group), and 128 developed MDS (96, 9 and 23 in each group). The 10-year cumulative incidence of AML/MDS was the highest in the anthracycline group (0.221% and 0.199%), followed by the non-anthracycline group (0.122% and 0.163%) and the control group (0.024% and 0.089%). The risk of developing AML/MDS was significantly higher in patients treated with anthracyclines (hazard ratio [HR] 9.531; p < 0.0001 for AML and HR 2.559; p < 0.0001 for MDS) compared to patients in the control group.

Conclusion: This study found that anthracycline-based adjuvant therapy significantly increased the risk of AML/MDS in Korean breast cancer patients, with the risk persisting for at least 10 years. While the cumulative incidence was low, the long-term risks of AML/MDS should be taken into account considering the poor outcomes associated with these neoplasms.

Keywords: Acute myeloid leukaemia; Adjuvant chemotherapy; Anthracycline; Breast cancer; Myelodysplastic syndrome.

MeSH terms

Anthracyclines
Antineoplastic Combined Chemotherapy Protocols / adverse effects
Breast Neoplasms* / complications
Chemotherapy, Adjuvant / adverse effects
Combined Modality Therapy
Female
Humans
Leukemia, Myeloid, Acute* / chemically induced
Leukemia, Myeloid, Acute* / drug therapy
Leukemia, Myeloid, Acute* / epidemiology
Myelodysplastic Syndromes* / chemically induced
Myelodysplastic Syndromes* / epidemiology
Neoplasms, Second Primary* / chemically induced
Neoplasms, Second Primary* / drug therapy
Neoplasms, Second Primary* / epidemiology

Substances

Anthracyclines