Original Article

Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine

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Abstract

Exposure to ionizing radiation increases the risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), but such risks are not known in well-differentiated thyroid cancer (WDTC) patients treated with radioactive iodine (RAI). A total of 148 215 WDTC patients were identified from Surveillance, Epidemiology and End Results registries between 1973 and 2014, of whom 54% underwent definitive thyroidectomy and 46% received adjuvant RAI. With a median follow-up of 6.6 years, 77 and 66 WDTC patients developed MDS and MPN, respectively. Excess absolute risks for MDS and MPN from RAI treatment when compared to background rates in the US population were 6.6 and 8.1 cases per 100 000 person-years, respectively. Compared to background population rates, relative risks of developing MDS (3.85 (95% confidence interval, 1.7–7.6); P=0.0005) and MPN (3.13 (1.1–6.8); P=0.012) were significantly elevated in the second and third year following adjuvant RAI therapy, but not after thyroidectomy alone. The increased risk was significantly associated with WDTC size 2 cm or regional disease. Development of MDS was associated with shorter median overall survival in WDTC survivors (10.3 vs 22.5 years; P<0.001). These data suggest that RAI treatment for WDTC is associated with increased risk of MDS with short latency and poor survival.

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Acknowledgements

IRB approval (also in main manuscript text): The Cleveland Clinic Institutional Review Board has deemed studies using de-identified, publicly available data (such as those used herein) to be exempt from Institutional Review Board review.

Author contributions

All authors were involved in the preparation of this report. SM is the principal investigator who generated the study hypothesis and was involved in all aspects of the study, including study design, interpretation and writing of the report. RJM contributed to the study design, collecting data, analyzing data, interpreting data and writing of the report. TR contributed to designing the methodology and analyzing data. CP, AN, HEC, MK, DA, CN, DA, JPM, NM and MAS were involved in study design, data interpretation and guiding the research. All authors read and approved the manuscript before submission.

Author information

Affiliations

  1. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    • R J Molenaar
    • , A S Advani
    • , A T Gerds
    • , H E Carraway
    • , M Kalaycio
    • , A Nazha
    • , D J Adelstein
    • , D Angelini
    • , M A Sekeres
    •  & S Mukherjee
  2. Departments of Medical Biology and Medical Oncology, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    • R J Molenaar
  3. Division of Hematology/Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    • C Pleyer
  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    • T Radivoyevitch
  5. Department of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN, USA

    • S Sidana
  6. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    • A Godley
  7. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA

    • C Nasr
  8. Department of Translational Hematology and Oncologic Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    • J P Maciejewski
  9. Department of Hematology and Medical Oncology, Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    • N Majhail

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to S Mukherjee.

Supplementary information

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    Supplementary Material

Supplementary Information accompanies this paper on the Leukemia website (http://www.nature.com/leu)