Analysis On The Data Of 32 Patients With Therapy-related Myeloid Neoplasms

Objective To study the characteristics and related factors of the therapy-related myel oid neoplasms(t-MN)and therefore explore the significance of the long term complic ation of cytotoxic chemotherapy for primary tumors.Methods 2421 adult patients including 1150 cases with AML and 1217 cases with MDS was analyzed.In total,32 cases were classified as t-MNs including 26 cases with t-AML,6cases with t-MDS.13 of 32(40.6 %)patients were males,and 19(59.4 %)patients were females.The patient’s data were from 7 hospitals in Jiaodong peninsula between May 2012 and August 2017.In conjunction with clinical manifestations,bone marrow morphology,immunophenotype and cytogenetics,a diagnosis was made according to the WHO classification on myeloid neoplasms,2016.The data were analysed with descriptive statistics by SPSS.Results 1.The occurrence of t-MN was1.32%(32/2421)with a rate of 2.26% for t-AML(26/1150)and 0.47% for t-MDS(6/1271)respectively.2.Among the 26 t-AML,AML-M2(11cases)was the most common in t-AML,followed by AML-M5(7cases),and AML-M4(4cases).Breast cancer(10cases)was the most common among the primary malignancies,followed by lung cancer(4cases),gastric cancer(3cases),MPN(2cases),nasopharyngeal carcinoma(2cases),osteosarcoma(2cases),thyroid carcinoma(2cases),lymphoma(2cases),colon cancer(2cases),AML-M3(1case),esophageal cancer(1case),and ovarian cancer(1case).3.24 patients previously received initial treatment with chemotherapy alone,while only one patient received radiotherapy alone after the diagnosis of the primary malignancy.7patients received the combination treatment of both chemotherapy and radiotherapy.17 patients received alkylating agents,11 paatients received anthracycline antibiotics,1 patients received topoisomerase II inhibitors.4.Patients with t-MN were relatively common in elderly patient.12 patients(37.5%)were over 60 years of age at diagnosis.5.57.7 percent of t-AML patient(15 cases)had abnormal cytogenetic findings.Among them,14,2,and 10 patients had favorable,intermediate and high risk cytogenetic abnoemality respectively.Two patients had favorable cytogenetics,and 14 patients had intermediate cytogenetics,and 10 patients with very poor risk cytogenetics were identified.Complex karyotype was frequent.Six patients with t-MDS were divided into different groups according to IPSS-R.The number of high risk and intermediate risk group was 5 cases and 1case respectively,and there was no patient divided into low risk group.6.Among twenty-three patients who were all t-AML,eight patients(34.78%)got complete remission after two cycles of chemotherapy,while eleven patients had symptomatic treatment only.7.The median time to development of t-MN(latency)following the primary tumor was64.6 months(range 10–288m).The latency from primary tumors to t-MN was positive correlated with median survival time.8.Among the t-MN patients,median survival time was 7.4 months(range 1-30m),Among the t-MDS patients,median survival time was 6 months(range 3-13m)Among the t-AML patients,median survival time was 9 months(range 1-30m),5months(range 1-11m)in adverse risk cytogenetic group,7 months(range 1-30m)in intermediate risk cytogenetic group,and 11.5 months(range 9-14m)in favorable risk cytogenetic group.Patiets who received chemotherapy had a longer median survival time than those who received symptomatic treatment only.t-AML patients had a longer median survival time than t-MDS patients.Conclusions t-MN as a complication of radiotherapy and chemotherapy,has a high incidence and poor prognosis.Patients with t-MN should be treated actively to prolong the survival time of the patient with t-MN.