Therapy-related acute myeloid leukemia (t-AML) among patients who had received treatment for lung cancer resulted in short overall survival (OS) and was associated with small cell histology, localized or regional stage disease, and chemoradiation therapy, according to a retrospective study published in BMC Cancer.
Although rare, t-AML is a known potential complication associated with lung cancer treatment. However, its characteristics, risk factors, and associated survival have not been well studied. The purpose of this study was to identify the clinicopathologic features of t-AML among patients with lung cancer.
The retrospective study analyzed data from 104 patients who developed t-AML after lung cancer treatment in the Surveillance, Epidemiology, and End Results (SEER) database. Patients had been diagnosed with t-AML between 1975 and 2015.
There were also 158,541 patients with lung cancer not diagnosed during the same time frame with t-AML included in the study.
Baseline characteristics were similar between the study groups, except more patients in the t-AML group underwent surgical treatment, radiation treatment, and had localized/regional stage disease compared with patients who did not develop t-AML. The median age of patients at lung cancer diagnosis was 63 years, 54% of patients were male, and 83% were white.
The estimated rate of t-AML was 3.66 cases per 10,000 persons, with a standardized incidence ratio (SIR) of t-AML of 4.00 (95% CI, 3.28-4.82). The SIR was highest between 36 months and 59 months after lung cancer diagnosis (9.29; 95% CI, 6.35-13.11), followed by 12 months to 35 months after diagnosis (5.35; 95% CI, 3.87-7.21). It was also higher among patients younger than 65 years (9.08; 95% CI, 6.74-11.97).
The time period of lung cancer diagnosis was also associated with differences in SIR, with the incidence highest among individuals diagnosed between 1975 and 1984 (5.99; 95% CI, 2.41-12.35) and lowest among those diagnosed between 2005 and 2015 (3.79; 95% CI, 2.88-4.88).
In a multivariate logistic regression analysis, risk factors significantly associated with the development of t-AML included surgical or radiation treatment, localized or regional disease, and small cell histology.
During a median follow-up time of 37.8 months among patients with t-AML, the median OS was 1 month (95% CI, 0.4-1.6 months) and rates for 6 months, 1 year , 2 years, and 5 years of 25%, 13%, 6%, and 3%, respectively. Patients younger than 65 years had a median OS of 4 months, whereas patients 65 years and older had a median survival of less than 1 month.
The authors concluded that “t-AML is a rare but serious late complication of patients with lung cancer and has a poor prognosis.” They added that these results are “valuable when explaining the risk of developing t-AML among patients with lung cancer.”
Wang H, Yin Y, Want R, et al. Clinicopathological features, risk and survival in lung cancer survivors with therapy-related acute myeloid leukaemia. BMC Cancer. 2020;20:1081. doi:10.1186/s12885-020-07603-9