Mayo Clinic Cancer Center, Phoenix, Arizona.
Mayo Clinic Cancer Center, Rochester, Minnesota.
JAMA Oncol. 2020 Jul 1;6(7):1086-1092. doi: 10.1001/jamaoncol.2020.0078.
Peptide receptor radionuclide therapy (PRRT) is a tumor-targeted treatment that uses radiation to induce tumor cell death in neuroendocrine tumors (NET) via β particle-emitting radionuclide linked to a somatostatin peptide analog. Therapy-related myeloid neoplasm (t-MN) has been reported as a potential long-term and frequently lethal adverse event after PRRT. However, the incidence, time of diagnosis, and nature of t-MN is unclear. Therefore, a systematic review is helpful to study the incidence and characteristics of t-MN after PRRT in patients with NET.
To systematically evaluate the literature and report the incidence, time of diagnosis, and nature of t-MN after PRRT.
MEDLINE, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials for articles and abstracts reporting studies of different designs studying more than 1 patient (randomized clinical trials, prospective phase I or phase II, retrospective studies, and case series) were searched from database inception through April 2019. Studies of interest included patients with NET who were treated with PRRT and reported the incidence of t-MN, if any. The primary outcome was the incidence of t-MN.
Twenty-eight articles were identified comprising 7334 patients who were treated with PRRT for NET. The main reason of exclusion was not reporting the t-MN incidence. The incidence of t-MN was variable between studies with mean (SD) incidence of 2.61% (4.38%). Of all 134 cases, cytogenetic abnormalities were reported in 32 patients with the most common abnormality being complex cytogenetics, consistent with myeloid neoplasms following exposure to alkylating agents or irradiation.
The risk of t-MN after PRRT is small but not insignificant given the poor prognosis after t-MN diagnosis. Close monitoring is warranted to identify such patients early in the disease course when hematologic abnormalities persist.
肽受体放射性核素疗法（PRRT）是一种肿瘤靶向治疗，通过将与生长抑素类似物结合的β粒子发射放射性核素用于神经内分泌肿瘤（NET），诱导肿瘤细胞死亡。在 PRRT 后，治疗相关髓系肿瘤（t-MN）已被报道为一种潜在的长期且频繁致命的不良事件。然而，t-MN 的发病率、诊断时间和性质尚不清楚。因此，系统评价有助于研究 NET 患者 PRRT 后 t-MN 的发病率和特征。
系统评价文献，报告 PRRT 后 t-MN 的发病率、诊断时间和性质。
从数据库创建到 2019 年 4 月，通过 MEDLINE、Embase、Scopus、Web of Science 和 Cochrane 对照试验中心注册库，对报道不同设计研究的文章和摘要进行了检索，这些研究包括治疗 NET 的 PRRT 治疗超过 1 例患者的随机临床试验、前瞻性 I 期或 II 期、回顾性研究和病例系列研究。有兴趣的研究包括接受 PRRT 治疗并报告任何 t-MN 发病率的 NET 患者。主要结局是 t-MN 的发病率。
确定了 28 篇文章，共纳入 7334 例接受 PRRT 治疗 NET 的患者。排除的主要原因是未报告 t-MN 发病率。研究之间 t-MN 的发病率存在差异，平均（SD）发病率为 2.61%（4.38%）。在所有 134 例病例中，报告了 32 例患者存在细胞遗传学异常，最常见的异常是复杂细胞遗传学，与接触烷化剂或辐射后发生的髓系肿瘤一致。
鉴于 t-MN 诊断后预后不良，PRRT 后发生 t-MN 的风险虽然较小，但不容忽视。需要密切监测，以在疾病早期发现持续存在血液学异常的此类患者。
