Joshi Utsav, Bhattarai Adheesh, Gaire Suman, Budhathoki Pravash, Agrawal Vishakha, Subedi Roshan, Poudyal Bishesh S, Dhakal Prajwal, Sham Ronald, Bhatt Vijaya R
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
Department of Internal Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Hematol Oncol Stem Cell Ther. 2023 Jul 20;17(1):79-87. doi: 10.56875/2589-0646.1113.
Therapy-related acute myeloid leukemia (tAML) is a serious complication in patients with Non-Hodgkin lymphoma (NHL) exposed to chemotherapy or radiation. This extensive database study aims to quantify the risk of tAML in NHL and determine the impact of tAML on the overall survival (OS) of patients with NHL.
Patients diagnosed with NHL and de novo AML from 2009 to 2018 were identified from the Surveillance, Epidemiology, and End Results database. Multiple primary standardized incidence ratio (SIR) sessions of the SEER*Stat software were used to calculate SIR and the absolute excess risk of tAML. Overall survival (OS) was evaluated using Kaplan-Meier curves and compared using log-rank tests. Multivariate analysis was used to study the role of each covariate on OS in patients with tAML.
The SIR of tAML was 4.89 (95% CI 4.41-5.41), with a higher incidence of tAML observed for age <60 years, NHL prior to 2013 and within 5 years of diagnosis, and those who received chemotherapy. NHL patients with tAML had lower OS than those without tAML (5-year OS 59% vs. 13%, p < 0.001). Patients with tAML showed worse OS than de novo AML in univariate analysis (5-year OS 13% vs. 25%, p = 0.001) but not in multivariate analysis (HR 0.93, 95% CI 0.82-1.04, p = 0.21). Age ≥60 years and lack of chemotherapy were associated with poor OS in tAML subcategory.
Age, time since NHL diagnosis, and receipt of chemotherapy directly influence the risk of development of tAML in NHL survivors.
治疗相关的急性髓系白血病（tAML）是接受化疗或放疗的非霍奇金淋巴瘤（NHL）患者的一种严重并发症。这项广泛的数据库研究旨在量化NHL患者发生tAML的风险，并确定tAML对NHL患者总生存期（OS）的影响。
从监测、流行病学和最终结果数据库中确定2009年至2018年诊断为NHL和原发性急性髓系白血病的患者。使用SEER*Stat软件的多个原发性标准化发病率比（SIR）程序来计算SIR和tAML的绝对超额风险。使用Kaplan-Meier曲线评估总生存期（OS），并使用对数秩检验进行比较。多变量分析用于研究每个协变量对tAML患者OS的作用。
tAML的SIR为4.89（95%CI 4.41-5.41），年龄<60岁、2013年之前及诊断后5年内的NHL患者以及接受化疗的患者中tAML发病率更高。患有tAML的NHL患者的OS低于未患tAML的患者（5年OS 59%对13%，p<0.001）。在单变量分析中，患有tAML的患者的OS比原发性急性髓系白血病患者更差（5年OS 13%对25%，p = 0.001），但在多变量分析中并非如此（HR 0.93，95%CI 0.82-1.04，p = 0.21）。年龄≥60岁和未接受化疗与tAML亚组中较差的OS相关。
年龄、自NHL诊断后的时间以及化疗的接受情况直接影响NHL幸存者发生tAML的风险。
