2003 - 2014年澳大利亚维多利亚州与治疗相关的急性髓系白血病和骨髓增生异常综合征

Therapy-related acute myeloid leukaemia and myelodysplastic syndrome in Victoria, Australia 2003-2014.

作者信息

Ong Doen Ming, Farrugia Helen, Wei Andrew

机构信息

Department of Haematology, Western Health, Melbourne, Victoria, Australia.

Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.

出版信息

Intern Med J. 2018 Jul;48(7):822-829. doi: 10.1111/imj.13714.

DOI:10.1111/imj.13714

PMID:29236346

Abstract

BACKGROUND

The burden of therapy-related acute myeloid leukaemia (tAML)/therapy-related myelodysplastic syndrome (tMDS) in Australia has not been characterised.

AIMS

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.

METHODS

We analysed adults aged ≥20 years at diagnosis of AML/MDS reported to the Victorian Cancer Registry (VCR) between 2003 and 2014.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

目的

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。

方法

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。

结果

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。