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Acute myeloid leukemia

Defining AML and MDS second cancer risk dynamics after diagnoses of first cancers treated or not with radiation


Risks of acute myeloid leukemia (AML) and/or myelodysplastic syndromes (MDS) are known to increase after cancer treatments. Their rise-and-fall dynamics and their associations with radiation have, however, not been fully characterized. To improve risk definition we developed SEERaBomb R software for Surveillance, Epidemiology and End Results second cancer analyses. Resulting high-resolution relative risk (RR) time courses were compared, where possible, to results of A-bomb survivor analyses. We found: (1) persons with prostate cancer receiving radiation therapy have increased RR of AML and MDS that peak in 1.5–2.5 years; (2) persons with non-Hodgkin lymphoma (NHL), lung and breast first cancers have the highest RR for AML and MDS over the next 1–12 years. These increased RR are radiation specific for lung and breast cancer but not for NHL; (3) AML latencies were brief compared to those of A-bomb survivors; and (4) there was a marked excess risk of acute promyelocytic leukemia in persons receiving radiation therapy. Knowing the type of first cancer, if it was treated with radiation, the interval from first cancer diagnosis to developing AML or MDS, and the type of AML, can improve estimates of whether AML or MDS cases developing in this setting are due to background versus other processes.

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We thank Drs Li Li and Cornelis Van Noorden for suggestions and the R community for software. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. We used data obtained from the Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan. RERF is a public interest foundation funded by the Japanese Ministry of Health, Labour and Welfare (MHLW) and the U.S. Department of Energy (DOE), the latter in part through DOE award DE-HS0000031 to the National Academy of Sciences. Conclusions in this report are those of the authors and do not necessarily reflect the scientific judgment of RERF or its funding agencies. This work was supported by: the Cleveland Clinic, the National Aeronautics and Space Administration (NNJ13ZSA001N) (TR), the National Institute for Health Research Biomedical Research Centre funding scheme (RPG), and the Academic Medical Center of Amsterdam (RJM).

Author contributions

JPM initiated and motivated the study. TR developed the software and wrote the first draft. RKS, DJB and RPG helped with the A-bomb data analyses. RJM helped with SEER*Stat comparisons. RPG, JPM, MAS, BTH, RJM, HEC and SM contributed feedback/guidance and writing.

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Correspondence to T Radivoyevitch.

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Radivoyevitch, T., Sachs, R., Gale, R. et al. Defining AML and MDS second cancer risk dynamics after diagnoses of first cancers treated or not with radiation. Leukemia 30, 285–294 (2016).

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