Risk of acute leukemia following epirubicin-based adjuvant chemotherapy: A report from the National Cancer Institute of Canada Clinical Trials Group
Risk of acute leukemia following epirubicin-based adjuvant chemotherapy: A report from the National Cancer Institute of Canada Clinical Trials Group
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DOI：
10.1200/jco.2003.08.137
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发表时间：
2003-08-15
影响因子：
45.3
通讯作者：
Pritchard, K
中科院分区：
文献类型：
--
作者：
Crump, M;Tu, DS;Pritchard, K
目的：环磷酰胺、表阿霉素和氟尿嘧啶（CEF）与经典环磷酰胺、甲氨蝶呤和氟尿嘧啶（CMF）化疗的比较。已导致改善绝经前淋巴结阳性乳腺癌妇女的无复发生存率和总生存率。我们进行这项分析是为了更准确地确定含表柔比星的化疗方案后继发性急性白血病（sAL）的风险估计。我们评估了1,545名接受辅助治疗的妇女中sAL的条件概率。（n = 1，477）或新辅助化疗（n = 68）在1990年至1999年的4项加拿大国家癌症研究所临床试验组试验。与含表柔比星的方案（CEF或表柔比星和环磷酰胺[EC]）和其他方案（阿霉素和环磷酰胺[AC]或CMF）相关的风险进行了determined.Results：共观察到10例sAL（8例急性髓细胞白血病，2例急性淋巴细胞白血病）：7例接受CEF治疗的女性，2例接受AC治疗，1例CMF治疗。使用竞争风险统计，sAL的条件概率为1.7%（95%置信区间[CI]，0.5至3.6）在539名接受CEF化疗的女性中，随访8年，0.4%（95% CI，0%-1.3%），231例接受AC治疗的患者中为1.3%（95% CI，0%-4.7%）。在所有4项试验中，所有接受含表柔比星方案治疗的女性患者8年时因乳腺癌死亡的条件概率约为34.9%。结论：与CMF相比，CEF方案治疗乳腺癌的sAL风险略有增加。这些急性白血病风险的估计在与女性讨论治疗时很重要，特别是乳腺癌死亡风险较低的患者，如淋巴结阴性乳腺癌患者。
Purpose : Cyclophosphamide, epirubicin, and fluorcuracil (CEF), compared with classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. has lead to an improvement in relapse-free and overall survival in premenopausal women with node-positive breast cancer. We undertook this analysis to more accurately define the estimate of risk of secondary acute leukemia (sAL) following epirubicin-containing chemotherapy regimens.Patients and Methods: We assessed the conditional probability of sAL among 1,545 women who received adjuvant (n = 1,477) or neoadjuvant (n = 68) chemotherapy in four National Cancer Institute of Canada Clinical Trials Group trials from 1990 to 1999. The risks associated with epirubicin-containing regimens (CEF or epirubicin and cyclophosphamide [EC]) and other regimens (doxorubicin and cyclophosphamide [AC] or CMF) were determined.Results: A total of 10 cases of sAL were observed (eight acute myelogeneous leukemia, two acute lymphoblastic leukemia): seven among women treated with CEF, two who had received AC, and one following CMF. Using competing risk statistics, the conditional probability of sAL was 1.7% (95% confidence interval [CI], 0.5 to 3.6) among 539 women treated with CEF chemotherapy at a follow-up of 8 years, 0.4% (95% CI, 0% to 1.3%) among the 678 who received CMF, and 1.3% (95% Cl, 0% to 4.7%) among the 231 treated with AC. The conditional probability of death from breast cancer at 8 years for the entire group of women treated with epirubicin-containing regimens in all four trials was approximately 34.9%.Conclusion: CEF chemotherapy for breast cancer carries a small increased risk of sAL compared with CMF. These estimates of acute leukemia risk are important in discussing treatment with women, especially patients with a lower risk of death from breast cancer, such as those with node-negative breast cancer.