Abstract
Background:
The increasing survival rate of patients with non-Hodgkin lymphoma has allowed the diagnosis of long-term complications including therapy related myeloid malignancies (t-MDS/t-AML).
Methods:
To determine the frequency of late-onset cytopenias, as well as t-MDS/t-AML in patients with lymphoproliferative malignancies, a cohort followed from Jan 2011-Dec 2016 including patients with either Follicular Lymphoma (FL) or Diffuse Large B Cell Lymphoma (DLBCL) was reviewed. Inclusion criteria: patients that received full treatment at Instituto Nacional de Cancerología (INCAN), who achieved full hematologic recovery at the end of treatment, and thereafter developed any degree of cytopenia (according to the CTCAE v4.0). Exclusion criteria: Follow-up less than 6 months and previous treatment before receiving medical care at INCAN. Initially peripheral causes (vitamin deficiencies, viral infections, liver autoimmune diseases, among others) were discarded. Thereafter, bone marrow aspiration was performed for morphologic analysis (including cellularity), karyotype and FISH panel. Baseline data was compared between groups with cytopenias and without it, with X2 method. A Cox-regression model evaluated the factors involved in the development of cytopenias. Survival was estimated with Kaplan-Meier method.
Results:
Of 840 patients enrolled, 35 developed cytopenias (4.16%) (23-DLBCL & 12-FL). Causes of cytopenia were: medullar hypoplasia (n=4, 11.4%), transitory cytopenia (n=4, 11.4%), t-MDS (n=8, 22.8%), t-AML (n=2, 5.7%) among others. In patients with FL, only hemoglobin <12 g/dL (p=0.032) and >6 nodal areas (p=0.037) at diagnosis were statistically significant factors for the development of cytopenia; no factor was significant in patients with DLBCL. It is of interest that 80% of patients developing t-MDS also received radiotherapy. Anemia was the most frequent cytopenia in patients with DLBCL (22.8%) and pancytopenia was the most frequent in FL (54.5%). For patients with t-MDS or t-AML (table 1), there was a gender predominance in women (66.7%). Patients with complex karyotype were associated with progression to t-AML, those with t(11q23) and -7 had aggressive clinical course and shorter survival. Treatment details and outcomes are summarized in table 1.
Conclusions:
The incidence of t-MN is increasing as more patients survive their primary cancers. It is quite important to get further knowledge on the molecular biology of the group of therapy-related disorders not only for a better diagnostic and classification criteria, which may help in selecting individualized treatments, but also to investigate potential chemopreventive strategies.
No relevant conflicts of interest to declare.
