Myelodysplastic syndrome and acute myeloid leukemia following adjuvant chemotherapy with and without granulocyte colony-stimulating factors for breast cancer.
Myelodysplastic syndrome and acute myeloid leukemia following adjuvant chemotherapy with and without granulocyte colony-stimulating factors for breast cancer.
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DOI：
10.1007/s10549-015-3590-1
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发表时间：
2015-11
影响因子：
3.8
通讯作者：
Kaplan HG
中科院分区：
文献类型：
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作者：
Calip GS;Malmgren JA;Lee WJ;Schwartz SM;Kaplan HG
乳腺癌辅助化疗和粒细胞集落刺激因子（G-CSF）治疗后骨髓增生异常综合征（MDS）和急性髓性白血病（AML）的风险尚未完全确定。我们的目的是评估与特定乳腺癌治疗相关的MDS/AML风险。我们使用监测、流行病学和最终结果-医疗保险数据库，对2001年至2009年间年龄≥66岁的I-III期乳腺癌妇女进行了回顾性队列研究。妇女被分类为接受放疗、化疗和/或G-CSF的治疗。我们使用多变量Cox比例风险模型来估计MDS/AML风险的调整风险比（HR）和95%置信区间（CI）。在56,251例乳腺癌病例中，1.2%在中位随访3.2年期间发展为MDS/AML。47.1%的女性接受放疗，14.3%接受化疗。与单纯手术治疗的乳腺癌患者相比，化疗（HR=1.38, 95%-CI: 0.98-1.93）和化疗/放疗（HR=1.77, 95%-CI: 1.25-2.51）组MDS/AML风险增加；而非单纯放疗（HR=1.08, 95% CI: 0.86-1.36）。在化疗方案和G-CSF中，MDS/AML风险与含蒽环类药物/环磷酰胺方案（HR=1.86, 95%-CI: 1.33-2.61）和非格昔汀（HR=1.47, 95%-CI: 1.05-2.06）存在差异，但与聚非格昔汀无关（HR=1.10, 95%-CI: 0.73-1.66）。我们观察到，在接受蒽环类/环磷酰胺化疗的老年乳腺癌幸存者中，G-CSF增强了MDS/AML的风险。虽然很小，但在确定乳腺癌患者的辅助化疗和预防中性粒细胞减少时，这种风险值得考虑。
Risk of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) post-breast cancer treatment with adjuvant chemotherapy and granulocyte colony-stimulating factors (G-CSF) is not fully characterized. Our objective was to estimate MDS/AML risk associated with specific breast cancer treatments. We conducted a retrospective cohort study of women ages ≥66 years with stage I-III breast cancer between 2001 and 2009 using the Surveillance, Epidemiology and End Results-Medicare database. Women were classified as receiving treatment with radiation, chemotherapy and/or G-CSF. We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for MDS/AML risk. Among 56,251 breast cancer cases, 1.2% developed MDS/AML during median follow-up of 3.2 years. 47.1% of women received radiation and 14.3% received chemotherapy. Compared to breast cancer cases treated with surgery alone, those treated with chemotherapy (HR=1.38, 95%-CI: 0.98–1.93) and chemotherapy/radiation (HR=1.77, 95%-CI: 1.25–2.51) had increased risk of MDS/AML; but not radiation alone (HR=1.08, 95% CI: 0.86–1.36). Among chemotherapy regimens and G-CSF, MDS/AML risk was differentially associated with anthracycline/cyclophosphamide-containing regimens (HR=1.86, 95%-CI: 1.33–2.61) and filgrastim (HR=1.47, 95%-CI: 1.05–2.06), but not pegfilgrastim (HR=1.10, 95%-CI: 0.73–1.66). We observed increased MDS/AML risk among older breast cancer survivors treated with anthracycline/cyclophosphamide chemotherapy that was enhanced by G-CSF. Although small, this risk warrants consideration when determining adjuvant chemotherapy and neutropenia prophylaxis for breast cancer patients.