A review of therapy-related myelodysplastic syndromes and acute myeloid leukaemia (t-MDS/AML) in Irish patients: a single centre experience

Figures & data

Table 1. Details of primary disorders for 39 patients with t-MN.

Type	Primary disorder	Total number
Solid tumour (15, 38.4%)	Prostate Breast Colon Lungs Ovarian Uterine TCC	5 4 2 1 1 1 1
Haematological malignancy (24, 61.5%)	AML MPN ALL NHL High grade Low grade HL Myeloma POEMS syndrome CLL HCL	5 1 1 5 4 1 1 7 1 2 1
Non-neoplastic disorder (4, 10.3%)	Rheumatoid arthritis Fibrosing alveolitis AIHA Inflammatory bowel disease	1 1 1 1
More than one disorder (4, 10.3%)	Breast/ovary Myeloma/TCC Prostate/AML Prostate/IBD	1 1 1 1

Note: TCC: Transitional cell carcinoma of urinary bladder; ALL: acute lymphoblastic leukaemia; NHL: non-Hodgkin lymphoma; HL: Hodgkin lymphoma, CLL: chronic lymphocytic leukaemia; HCL: hairy cell leukaemia; AIHA: autoimmune haemolytic anaemia; IBD: inflammatory bowel disease.

Table 2. Prior exposure to cytotoxic agents and radiotherapy for 39 patients with t-MN.

Agents	Number of patients
Alkylating agents: Melphalan, Cyclophosphamide, Nitrogen mustard, Chlorambucil, Busulphan, Carboplatin, Cisplatin, Dacarbazine, Procabazine, Carmustine, Mitomycin C, Thiotepa, Lomustine	22
Ionizing radiation therapy: (seven patients also had chemotherapy)	12
Topoisomerase II inhibitors: Etoposide, Teniposide, Doxorubicin, Mitoxantrone, Amascrine, Actinomycin	17
Others: Antimetabolites: Thiopurine, Mycophenolate, Fludarabine Antitubuilin agents: Vincristine, Vinblastine, Vindesine, Paclitaxel, Docetexal	25
High dose therapy for autologous stem cell transplant	3

Patients who received alkylating agents alone = 10.

Patients who received topoisomerase II inhibitors alone = 5.

Table 3. Summary of latency, diagnostic features and survival of 39 patients with t-MN.

Category	Number (%)	Latency (months)	Survival (months)
Primary disorder Haematological disorder Solid tumour Autoimmune disease^1 More than one disorder^2	22 (56%) 10 (26%) 3 (8%) 4 (10%)	46 (3–132) 85 (2–366) 109 (28–131) 74 (24–181)	14 (<1–74) 37 (<1–122) 24 (18–29) 9 (5–13)
Primary therapy Chemotherapy alone  • Alkylating agents only  • Topoisomerase II inhibitors onlyRadiotherapy aloneCombined chemotherapy and radiotherapy	27 (69%) 10 5 5 (13%) 7 (18%)	56 (3–181) 67 (24–163) 14 (3–46) 13 (2–366) 84 (23–153)	14 (<1–122) 16 (1–122) 14 (14–57) 42 (<1–68) 7 (5–96)
Blast count in bone marrow
• <5%  • ≥5%	24 (62%) 15 (38%)	– –	23 (<1–122) 8 (1–96)
Cytogenetics (available in 34 patients) Normal Abnormal	14 (41%) 20 (59%)	67 (3–366) 45 (12–152)	31 (4–122) 13 (0–96)
IPSS-R Groups (available in 32 patients) Lower risk (very low, low, intermediate) Higher risk (high, very high)	16 (50%) 16 (50%)	61 (3–366) 49 (0–152)	31 (0–122) 11 (1–96)
Treatment received for t-MN Supportive care only Azacitidine Intensive chemotherapy/allogeneic stem cell transplant	22 (56%) 12 (31%) 5 (13%)	– – –	28 (<1–122) 11 (5–57) 14 (5–96)

Note: MPN: Myeloproliferative neoplasm; ASCT: autologous stem cell transplant; t-MN: therapy-related myeloid neoplasms.

¹Autoimmune haemolytic anaemia, rheumatoid arthritis, fibrosing alveolitis (received either Methotrexate or Azathioprine).

²Inflammatory bowel disease/prostate cancer, AML/prostate cancer, ovarian cancer/breast cancer, myeloma/urothelial cancer.

Figure 1. Cytogenetic findings and IPSS-R risk groups of 39 patients with t-MN. (a) Patients with t-MN based on cytogenetic findings. (b) Patients with t-MN according to IPSS-R risk groups.

Figure 2. Survival analysis of 39 patients with t-MN. (a) Overall survival of 39 patients with t-MN with time. (b) Comparison of overall survival between solid tumour and haematological malignancy groups. (c) Overall survival between lower and higher risk IPSS-R groups. (d) Overall survival and primary therapy. (e) Overall survival between higher and lower marrow blasts. (f) Overall survival between alkylating agents and topoisomerase II inhibitor-treated groups.