Myeloproliferative Neoplasms Occurring in Patients with a Cancer History
Liping Zhang, Wei Xie, Chi Young OK, L Jeffrey Medeiros, Sa A Wang. UT MD Anderson, Houston, TX; Methodist Hospital, Houston, TX
Background: Hematopoietic neoplasms occurring in patients with prior cytotoxic exposure include therapy-related myelodysplastic syndromes (t-MDS); t- myelodysplastic/myeloproliferative neoplasm (t-MDS/MPN), t-acute myeloid leukemia and infrequently therapy-related B-lymphoblastic leukemia. These neoplasms often harbor characteristic cytogenetic alterations that correlate with a poor prognosis in affected patients. Myeloproliferative neoplasms (MPN), as one of the frequent forms of hematopoietic neoplasms, has not been studied in this setting.
Design: We searched all patients with a diagnosis of MPN rendered at our hospital from 2005 to 2012 and further searched patients with a well-documented history of other malignancies. These cases were reviewed, and the final assessment was conducted in conjunction with follow-up bone marrow (BM) biopsy, clinical laboratory data and molecular cytogenetic information.
Results: From a denominator of 4,126 MPN patients, 32 patients with other malignancies were identified. Of these 32 patients, 15 patients developed MPN either prior to or concurrent with the cancer diagnosis; 8 patients had cancer treated with surgical procedure only; and only 9 (0.02%) patients received chemoradiation cancer therapy prior to MPN diagnosis. These 9 cases included 3 chronic myelogenous leukemia, 2 polycythemia vera, 2 MPN-unclassifiable, 1 primary myelofibrosis and 1 essential thrombocythemia. Conventional cytogenetics showed no evidence of -5, -7, inv(3), 11q23 abnormalities or a complex karyotype that commonly seen in t-MN. These patients responded to therapies tailored to each type of MPN. With a median follow-up of 27.8 months, none of the patients died. The survival of these 9 patients was comparable to the 23 patients with cancer but no cytotoxic exposure; and significantly better than that of patients with t-MDS (median, 12.7 months) in our historic database consisting of 421 patients.
Conclusions: MPN occurring in patients with a history of cancer is infrequent. The survival and cytogenetic findings of patients are different from patients with t-MDS, t-AML and t-MDS/MPN. These findings indicate that the MPN occurring in this setting likely due to individual genetic susceptibility to cancer or could be coincidental.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 221, Wednesday Morning