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Risk factors for second acute myeloid leukemia/myelodysplastic syndrome among survivors of non-Hodgkin lymphoma

Leukemia volume 30, pages 1187–1190 (2016)Cite this article

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Non-Hodgkin lymphoma (NHL) survivors are at increased risk for developing acute myeloid leukemia/myelodysplastic syndrome (AML/MDS), a rare but often fatal complication of chemotherapy.1 Previous studies have demonstrated particularly elevated risks associated with fludarabine and, to a lesser extent, cyclophosphamide, likely due to the direct genotoxic effects of these agents.1 Several studies have suggested that immune dysfunction also may contribute to AML/MDS risk in the general population, with increased risks associated with certain autoimmune disease and infections.2, 3, 4, 5 However, no previous study has considered whether these conditions may also be risk factors for AML/MDS among NHL survivors.

To investigate the potential contribution of autoimmune diseases and infections as well as treatments to AML/MDS after NHL, we used the SEER-Medicare database linkage to assemble a cohort of 33 922 Medicare enrollees who were diagnosed with first primary NHL during 2000–2009 at ages 66–83 years. Follow-up began 1 year after NHL diagnosis and continued until diagnosis of second primary malignancy, age 85 years, death, loss to follow-up, or end of study (31 December 2009), whichever came first. Survivors were required to have continuous fee-for-service Medicare Parts A and B coverage ⩾12 months before NHL diagnosis through ⩾12 months following NHL diagnosis for ascertainment of treatment and medical conditions. Patients who survived <1 year after NHL diagnosis (N=1157) or had Medicare claims for HIV (N=171), solid organ transplantation (N=107), or hematopoietic stem cell transplantation (N=226) were excluded from the analysis.

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Acknowledgements

This research was supported by the Intramural Program of the National Institutes of Health, National Cancer Institute.

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Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    C J K Lam, R E Curtis, G M Dores, E A Engels, N E Caporaso, J F Fraumeni, M A Tucker & L M Morton

  2. Department of Epidemiology and Biostatistics, The George Washington University Milken Institute School of Public Health, Washington, DC, USA

    C J K Lam, H A Young, P H Levine & A F Elmi

  3. Department of Hematology, Hadassah University Hospital, Jerusalem, Israel

    A Polliack

  4. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    J L Warren

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  1. C J K Lam
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  2. R E Curtis
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Correspondence to L M Morton.

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Lam, C., Curtis, R., Dores, G. et al. Risk factors for second acute myeloid leukemia/myelodysplastic syndrome among survivors of non-Hodgkin lymphoma. Leukemia 30, 1187–1190 (2016). https://doi.org/10.1038/leu.2015.248

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