Use of white blood cell growth factors and risk of acute myeloid leukemia or myelodysplastic syndrome among elderly patients with non-Hodgkin lymphoma.
Use of white blood cell growth factors and risk of acute myeloid leukemia or myelodysplastic syndrome among elderly patients with non-Hodgkin lymphoma.
复制标题
白细胞生长因子的使用与老年非霍奇金淋巴瘤患者患急性髓性白血病或骨髓增生异常综合征的风险。
作者：
Gruschkus,StephenK;Lairson,David;Dunn,JKay;Risser,Jan;Du,XianglinL
背景：本研究旨在评估大量接受化疗的老年非霍奇金淋巴瘤(NHL)患者中使用集落刺激因子(CSF)与发生与治疗相关的骨髓增生异常综合征或急性髓系白血病(t-MDS/AML)的风险。方法从1992年至2002年的监测、流行病学和最终结果-Medicare数据库中确定13203名NHL患者。患者从最初的化疗日期到他们被诊断为t-MDS/AML、死亡或最后一次随访(2006年10月31日)，以发生时间较早者为准。结果40%(n=5266)的患者接受了脑脊液治疗。在随访期间(中位随访期2.9年，范围1-14.7年)，接受脑脊液治疗的患者272例(5.2%)发生t-MDS/AML，而未接受治疗的患者230例(2.9%)发生t-MDS/AML(P<；.0001，LOG检验)。接受脑脊液治疗的患者的t-MDS/AML 5年发病率为14.1/1000人年，而未接受脑脊液治疗的患者为8.3/1000人年。在对性别、组织学、分期、合并症、放疗和化疗药物进行校正的多变量Cox回归分析中，发现使用脑脊液与t-MDS/AML风险增加53%独立相关(风险比[HR]，1.53；95%可信区间[95%CI]，1.26-1.84)。观察到的脑脊液使用与t-MDS/AML之间的联系在组织学亚组(即弥漫性大B细胞淋巴瘤、滤泡性淋巴瘤和其他)中持续存在。同时接受脑脊液和抗代谢药物化疗的患者与未接受化疗的患者相比，t-MDS/AML的风险增加了2.5倍(HR，2.49；95%CI，1.91-3.26)。结论目前的研究，据我们所知，这是迄今为止发表的第一项基于人群的大型研究，表明接受化疗的老年NHL患者应用CSF与t-MDS/AML的风险增加有关，尽管绝对风险很低。癌症2010年。©2010美国癌症协会。
BACKGROUNDThe current study was conducted to evaluate the association between colony‐stimulating factor (CSF) use and the risk of developing therapy‐related myelodysplastic syndromes or acute myeloid leukemia (t‐MDS/AML) among a large cohort of elderly patients with non‐Hodgkin lymphoma (NHL) who were treated with chemotherapy.METHODSA total of 13,203 NHL patients were identified from the Surveillance, Epidemiology, and End Results‐Medicare database who were diagnosed from 1992 through 2002. Patients were followed from their initial chemotherapy date until the date they were diagnosed with t‐MDS/AML, death, or last follow‐up (October 31, 2006), whichever occurred first.RESULTSOverall, 40% (n = 5266) of patients received CSF. During the follow‐up period (median follow‐up, 2.9 years [range, 1‐14.7 years]), 272 (5.2%) patients who were treated with CSF developed t‐MDS/AML, compared with 230 (2.9%) patients who did not (P< .0001, log‐rank test). The 5‐year incidence of t‐MDS/AML for patients receiving CSF was 14.1 per 1000 person‐years compared with 8.3 per 1000 person‐years for patients not receiving CSF. In a multivariable Cox regression analysis adjusted for gender, histology, stage, comorbidities, radiotherapy, and chemotherapy agent, CSF use was found to be independently associated with a 53% increased risk of t‐MDS/AML (hazard ratio [HR], 1.53; 95% confidence interval [95% CI], 1.26‐1.84). The observed association between CSF use and t‐MDS/AML persisted across histologic subgroups (ie, diffuse large B‐cell lymphoma, follicular lymphoma, and others). Patients who received both CSF and antimetabolite chemotherapy were found to have a 2.5‐fold increased risk of t‐MDS/AML (HR, 2.49; 95% CI, 1.91‐3.26) compared with patients who received neither agent.CONCLUSIONSThe current study, which to our knowledge is the first large population‐based study published to date, demonstrated that the administration of CSF among elderly NHL patients receiving chemotherapy was associated with an increased risk of t‐MDS/AML, although the absolute risk was low. Cancer 2010. © 2010 American Cancer Society.