Myelodysplastic Syndrome and Acute Myeloid Leukemia Risk Associated With Solid Tumor Chemotherapy

Therapy-related acute myeloid leukemia (tAML) and acute myeloid leukemia (AML) with myelodysplasia-related changes represent 2 distinct subcategories of the 2016 revision of the World Health Organization classification of myeloid neoplasm. Therapy-related myeloid neoplasms carry worse prognoses than de novo disease. The most common solid tumor types associated with therapy-related myelodysplastic syndrome (tMDS)/AML include breast cancer, lymphoma, and gynecologic cancers. The estimated proportion of therapy-related leukemia (including lymphoid and myeloid) among patients receiving chemotherapy for breast cancer or germ cell tumors is 1% to 5%. These secondary myeloid neoplasms are thought to have poor outcomes owing to the accumulation of chromosomal aberrations from prior chemotherapies because these chromosomal abnormalities confer more aggressive biological behavior and treatment recalcitrance. Though information about the specific chemotherapeutics that can lead to therapy-related myeloid neoplasm is available, there are no robust population-based cohort studies that explore the patient outcomes of solid tumor chemotherapy with regard to the risk for tMDS/AML. This information is highly desirable to oncologists because improved survival from primary cancers is associated with increased risk for secondary neoplasms later in life. To date, there have been no risk-assessment models to guide therapeutic decisions about solid tumor chemotherapeutics that carry a high risk for secondary malignant neoplasms within the hematopoietic compartment.

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