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Epidemiology

Risk of therapy-related myelodysplastic syndrome/acute myeloid leukemia after childhood cancer: a population-based study

Leukemia volume 33, pages 2947–2978 (2019)Cite this article

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Advances in therapy for childhood cancer and the resulting improved survival over time have led to a greater focus on the long-term health of childhood cancer survivors and risks for therapy-related adverse effects [1]. Therapy-related myelodysplastic syndrome/acute myeloid leukemia (tMDS/AML) are rare yet serious complications of cytotoxic cancer therapies [2]. Studies primarily conducted in adult cancer patients have demonstrated that tMDS/AML risk varies by the type of chemotherapy, with the highest risks for certain epipodophyllotoxins, alkylating agents, and platinum compounds [2].

The limited data available on tMDS/AML risk after childhood cancer derive primarily from case–control and cohort studies, conducted predominantly in patients treated in the 1980s [3,4,5,6] and 1990s [7]. However, chemotherapy regimens for many first primary cancers have evolved since the 1990s [8, 9]. Clinical trials also have reported tMDS/AML after childhood cancer [10,11,12,13], but most of them lack sufficient sample size to quantify rare adverse effects, such as tMDS/AML, and cannot compare risks by childhood cancer type. Two population-based studies reported increasing tAML risk after childhood cancer [14, 15]. However, those studies included a small number of cases (N = 36 and 54 cases), only included follow-up through the early 2000s, and did not evaluate risks separately for those treated with chemotherapy.

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Acknowledgements

This research was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health, and Department of Health and Human Services. The authors acknowledge the efforts of the National Cancer Institute and SEER Program tumor registries in the creation of the SEER database. Please note that the opinions and information in this article are those of the authors, and do not represent the views and/or policies of the U.S. Food and Drug Administration.

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Authors and Affiliations

  1. Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA

    Pragati G. Advani, Sara J. Schonfeld, Rochelle E. Curtis, Graça M. Dores, Martha S. Linet, Byron S. Sigel & Lindsay M. Morton

  2. U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Division of Epidemiology, Silver Spring, MD, USA

    Graça M. Dores

  3. The Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA

    Clara J. K. Lam

  4. Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA

    Margaret A. Tucker

  5. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA

    Stephen J. Chanock

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  1. Pragati G. Advani
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Correspondence to Pragati G. Advani.

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Presentation: These data were presented in part at the 2018 Conference on Radiation and Health, in Chicago, Illinois, September 23–25, 2018.

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Advani, P.G., Schonfeld, S.J., Curtis, R.E. et al. Risk of therapy-related myelodysplastic syndrome/acute myeloid leukemia after childhood cancer: a population-based study. Leukemia 33, 2947–2978 (2019). https://doi.org/10.1038/s41375-019-0520-y

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