Concomitant Presentation of Acute Myeloid Leukemia (AML) and Lung Cancer

Smoking is associated with AML and lung cancer, suggesting a common carcinogenic origin and raising the question of how to treat patients with concomitant cancer presentations. The Roswell Park Cancer Institute Tumor Registry was searched for patients with both diagnoses, followed by medical record review. Among 775 AML cases and 5225 lung cancer cases presented to Roswell Park Cancer Institute between January 1992 and May 2008 we identified twelve patients with both AML and lung cancer (1.5% of AML cases; 0.2% of lung cancer cases). Of these, seven cases had metachronous and five cases had synchronous presentation. Eleven of the twelve (92%) patients had a known smoking history; five (42%) of them were males. The median age at the respective diagnoses was 65 (range 58–85) years for AML and 66 (range 53–79) years for lung cancer. Five of the twelve (42%) patients had a complex karyotype.

Metachronous group: Lung cancer preceded AML in six patients by a median interval of eight (range five-14) years, while AML preceded the diagnosis of lung cancer in one patient by three years. For their lung cancer, five patients had surgical resection. Two had definitive chemoradiation, one patient had adjuvant chemotherapy and one patient had adjuvant radiation suggesting that their subsequent AML was secondary. Two patients had preceding MDS even though they underwent only surgical resection for their lung cancer. For their AML, five of the seven patients were treated with cytarabine and anthracycline-containing regimens; two achieved complete remission, two had primary refractory disease and one patient died during induction. One patient with primary refractory disease underwent sibling matched allogeneic transplantation and is still alive in remission. The median survival for lung cancer was 65 (range 22–120) months. The median survival since AML diagnosis was less than one (range <1–105) month. Five of the seven patients died from AML complications, one patient died of an unrelated cause and one patient is alive in remission.

Synchronous group: All five patients were treated initially for AML with cytarabine and anthracycline-containing regimens; two achieved complete remission, two had refractory disease and one patient had prolonged cytopenia. Two patients underwent surgical resection for their lung cancer after treatment for AML and one had palliative radiation. The median survival was five (range three-21) months and four of the five patients died of AML related causes.

Conclusions: Less than 2% of AML patients present with lung cancer. Prior chemoradiation for non small cell lung cancer may be a risk factor for secondary AML but does not explain development of AML in the majority of patients, suggesting a potential role of prior tobacco use as a common carcinogenic risk factor. Although AML and lung cancers both carry poor prognoses, our data imply that AML has a more aggressive course than lung cancer and is the main cause of mortality in these patients. This miniseries highlights again the need for enforcing smoking cessation.