Acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) following a diagnosis of breast cancer

Abstract

7051 Background: Increasing use of chemotherapy and radiation therapy in breast cancer patients in the adjuvant setting heightens concern about therapy-related AML and MDS. Little is known about the characteristics of these disorders following breast cancer. Methods: Roswell Park Cancer Institute (RPCI) patients with diagnoses of MDS or AML by French-American-British Group or World Health Organization criteria following breast cancer were retrospectively reviewed. Results: 34 women were identified between 1983 and 2006. 10 (29%) were also diagnosed with additional malignancies, including non-Hodgkin lymphoma (NHL), bladder, colon, lung, uterine and thyroid cancers, Ewing sarcoma and angiosarcoma. 23 of 31 patients (74%) with family histories documented had first-degree relatives with cancers, including breast, lung, colon, stomach, pancreas, prostate, renal, melanoma, esophagus, thyroid, Hodgkin lymphoma and leukemia, compared to a 45% prevalence of first-degree relatives with cancer among 1982 control RPCI breast cancer patients (p= 0.001). Median age at breast cancer diagnosis was 58 (range, 37–85) years. Among the 29 patients with known treatment, 25 (86%) had received radiation therapy, 13 (45%) had received chemotherapy, including alkylating agents in all 13 (45%) and topoisomerase II inhibitors in 8(28%), while 4 (14%) had received no adjuvant therapy. Median age at AML/MDS diagnosis was 70 (range, 46–90) years. 26 patients had AML and 8 MDS, of whom 4 progressed to AML. Karyotypes were complex in 10 (29%), involved 11q23 rearrangements in 6 (18%), were favorable, normal and unknown in 5 each (45%), and had miscellaneous single structural abnormalities in 3 (9%); they did not strictly correlate with treatment received. Median survival (months) was 1 for complex karyotype, 6 for 11q23 translocation and 40 for favorable karyotype patients. Conclusions: The incidence of other cancers and of cancers in family members was unexpectedly high in breast cancer patients with AML and MDS, in the absence of known genetic syndromes, suggesting genetic polymorphisms predisposing to multiple cancers. Cytogenetic abnormalities included complex, 11q23 and favorable karyotypes, and survival reflected karyotypes. No significant financial relationships to disclose.