Ong Doen Ming, Farrugia Helen, Wei Andrew
Department of Haematology, Western Health, Melbourne, Victoria, Australia.
Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.
Intern Med J. 2018 Jul;48(7):822-829. doi: 10.1111/imj.13714.
The burden of therapy-related acute myeloid leukaemia (tAML)/therapy-related myelodysplastic syndrome (tMDS) in Australia has not been characterised.
To provide insights into the incidence, associated cancers, latency and survival outcomes of patients with tAML/tMDS in Victoria, Australia, based on a state-wide cancer registry and to assess if these features are different in tAML/tMDS compared with de novo AML/MDS.
We analysed adults aged ≥20 years at diagnosis of AML/MDS reported to the Victorian Cancer Registry (VCR) between 2003 and 2014.
In total, 73 of 3120 (2.3%) AML cases were classified tAML. tAML patients were younger than non-tAML patients at diagnosis (median age 66 vs 71 years, P = 0.000). Median overall survival was similar (6 months). Median latency to tAML was 82 months, with two incidence peaks at 1-4 and 7-8 years. In total, 59 of 73 patients had recorded cancers, the most frequent being non-Hodgkin lymphoma (NHL, 32.2%) and breast cancer (16.9%). In total, 532 of 3120 (14.1%) additional AML cases had ≥1 prior cancer (confirmation of chemoradiotherapy unavailable). tAML incidence increased (0.0/100 000 persons in 2003, 0.5/100 000 persons in 2014), as did the incidence of non-tAML with previous cancer (0.8/100 000 persons in 2003, 1.1/100 000 persons in 2014). In total, 101 of 4435 (2.3%) MDS cases were classified tMDS. Although tMDS incidence fluctuated (range 0-0.4/100 000 persons/year), the incidence of non-tMDS with prior cancer rose (1.4/100 000 persons in 2003, 1.9/100 000 persons in 2014). Compared to tAML, the tMDS cohort was older (median age 70 vs 66 years, P = 0.007). Median latency to tMDS was 42.5 months. NHL was also the most common cancer preceding tMDS, but the second most common cancer was myeloma (17.8%). In total, 1287 of 5061 (20.3%) non-tMDS patients had a prior cancer.
The burden of tAML/tMDS in Victoria is likely to be underestimated. Linkage between VCR and clinical registries is needed to provide more accurate insights.
澳大利亚治疗相关急性髓系白血病（tAML）/治疗相关骨髓增生异常综合征（tMDS）的负担尚未明确。
基于全州癌症登记处，深入了解澳大利亚维多利亚州tAML/tMDS患者的发病率、相关癌症、潜伏期和生存结果，并评估tAML/tMDS与原发性AML/MDS相比这些特征是否不同。
我们分析了2003年至2014年期间向维多利亚癌症登记处（VCR）报告的诊断为AML/MDS时年龄≥20岁的成年人。
在3120例AML病例中，共有73例（2.3%）被归类为tAML。tAML患者诊断时比非tAML患者年轻（中位年龄66岁对71岁，P = 0.000）。中位总生存期相似（6个月）。tAML的中位潜伏期为82个月，在1 - 4年和7 - 8年有两个发病高峰。73例患者中共有59例记录有癌症，最常见的是非霍奇金淋巴瘤（NHL，32.2%）和乳腺癌（16.9%）。在3120例额外的AML病例中，共有532例（14.1%）有≥1次既往癌症（无法确认是否接受过放化疗）。tAML发病率上升（2003年为0.0/10万人口，2014年为0.5/10万人口），有既往癌症的非tAML发病率也上升（2003年为0.8/10万人口，2014年为1.1/10万人口）。在4435例MDS病例中，共有101例（2.3%）被归类为tMDS。尽管tMDS发病率有波动（范围为0 - 0.4/10万人口/年），但有既往癌症的非tMDS发病率上升（2003年为1.4/10万人口，2014年为1.9/10万人口）。与tAML相比，tMDS队列年龄更大（中位年龄70岁对66岁，P = 0.007）。tMDS的中位潜伏期为42.5个月。NHL也是tMDS之前最常见的癌症，但第二常见的癌症是骨髓瘤（17.8%）。在5061例非tMDS患者中，共有1287例（20.3%）有既往癌症。
维多利亚州tAML/tMDS的负担可能被低估。需要将VCR与临床登记处相联系以提供更准确的见解。
