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Risk of subsequent myeloid neoplasms after radiotherapy treatment for a solid cancer among adults in the United States, 2000–2014

Leukemiavolume 32pages25802589 (2018) | Download Citation


Although increased risk of acute myeloid leukemia (AML) has been observed after chemotherapy and radiotherapy, less is known about radiotherapy-related risks of specific AML subtypes and other specific myeloid neoplasms. We used the US population-based cancer registry data to evaluate risk of myeloid neoplasms among three cohorts of cancer survivors initially treated with radiotherapy only. We included 1-year survivors of first primary thyroid (radioiodine only, stages I–IV; N = 49 879), prostate (excluding stage IV; N = 237 439), or uterine corpus cancers (stage I–II; N = 16 208) diagnosed during 2000–2013. We calculated standardized incidence ratios (SIRs) and excess absolute risks (EARs). Thyroid cancer survivors had significantly elevated risks of total AML (SIR = 2.77, 95% CI: 1.99–3.76), AML with cytogenetic abnormalities (SIR = 3.90, 95% CI: 1.57–8.04), AML with myelodysplasia-related changes (SIR = 2.87, 95% CI: 1.05–6.25), and BCR-ABL1-positive chronic myelogenous leukemia (CML) (SIR = 5.38, 95% CI: 2.58–9.89). Irradiated prostate and uterine corpus cancer survivors were at elevated risk for total AML (SIR = 1.14, 95% CI: 1.03–1.27 and SIR = 1.77, 95% CI: 1.01–2.87, respectively), AML with cytogenetic abnormalities (SIR = 2.52, 95% CI: 1.84–3.37 and SIR = 7.21, 95% CI: 2.34–16.83, respectively), and acute promyelocytic leukemia (SIR = 3.20, 95% CI: 2.20–4.49 and SIR = 8.88, 95% CI: 2.42–22.73, respectively). In addition, prostate cancer survivors were at increased risk of BCR-ABL1-positive CML (SIR = 2.11, 95% CI: 1.52–2.85). Our findings support the importance of diagnostic precision in myeloid neoplasm classification since susceptibility following radiotherapy may vary by myeloid neoplasm subtype, thereby informing risk/benefit discussions in first primary cancer treatment.

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This study was supported by the Intramural Program of the National Cancer Institute, National Institutes of Health, Department of Health and Human Services and by the Dutch Cancer Society (Grant No. DCOG2011-5027 and UVA2012-5517).

Author information


  1. Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, The Netherlands

    • Jop C. Teepen
    • , Leontien C. M. Kremer
    •  & Cécile M. Ronckers
  2. Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands

    • Jop C. Teepen
    • , Marry M. van den Heuvel-Eibrink
    •  & Leontien C. M. Kremer
  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA

    • Rochelle E. Curtis
    • , Graça M. Dores
    • , Amy Berrington de Gonzalez
    • , Ethel S. Gilbert
    •  & Lindsay M. Morton
  4. Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    • Flora E. van Leeuwen


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The authors declare that they have no conflict of interest.

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Correspondence to Jop C. Teepen.

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