Clinicopathological features, risk and survival in lung cancer survivors with therapy-related acute myeloid leukaemia

Abstract

Background A secondary malignancy is the most serious complication in lung cancer (LC) survivors. This study aimed to evaluate the clinicopathological features, predictable risk factors and survival of patients with LC who developed therapy-related acute myeloid leukaemia (t-AML). Methods Patients from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with t-AML after LC between 1975 and 2015 were included. Standardized incidence ratios (SIRs) were used to perform multiple primary analyses. The risk of t-AML development among LC patients was assessed using a logistic regression model. Kaplan–Meier analysis was used to construct overall survival (OS) curves. Cox regression was used to assess the influence of various prognostic factors. Results A total of 104 patients with t-AML after LC-targeting chemotherapy were included. The median latency period to the development of t-AML was 35.5 months. The calculated SIR of t-AML was 4.00. Chemoradiotherapy, small cell lung cancer (SCLC), or localized/regional-stage LC was a risk factor for the development of t-AML. The median OS was only 1 month, and those younger than 65 years were predicted to have a better OS time. Conclusions t-AML is a rare but serious late complication in LC patients and is associated with a poor prognosis. It is necessary to carry out long-term follow-up and screen for t-AML in LC patients, especially among those undergoing both radiotherapy and chemotherapy, with SCLC or with localized/regional-stage LC.

Case report: Identification of acute promyelocytic leukemia during osimertinib resistance followed by granulocyte colony-stimulating factor and pembrolizumab

“…There was no mutation in any common AML prognostic gene, including FLT3, dupMLL, IDH1, IDH2, NPM1, KIT, NRAS, CEBPA, DNMT3A, PHF6, TET2, ASXL1, RUNX1, TP53, and WT1. Chromosome karyotypic analysis showed 46, XX, add (7, 11), t (15;17) (q24; q21) [6]/46, XX [14] (Figure 2). Subsequently, the patient underwent all-trans retinoic acid and arsenic acid induction therapy.…”

“…Chemotherapy, radiotherapy, or both for prior neoplasms are demonstrated contributors to the development of t-APL (4,6,7). Current therapeutic strategies for lung cancer have flourished due to the emergence of targeted agents, immunotherapy, and the transition from conventional radiotherapy to intensity-modulated radiotherapy (IMRT).…”

Recommendations for a practical implementation of circulating tumor DNA mutation testing in metastatic non-small-cell lung cancer

“…45 One benefit of including PBMCs might be a concurrent assessment of precursors of (therapy-related) hematological malignancies, given that clear cut-offs will be established for determining the relative or absolute risk of developing such diseases. 45,52 In addition to a paired plasma and PBMC analysis, variant filters based on association of a mutation with CHIP as well as functional annotation of a somatic variant as an oncogene activating event can be used to filter for CH-related variants. 53 A better understanding of biophysical features (e.g.…”