P4-12-11: Myelodysplastic Syndrome Post Primary Breast Cancer Treatment: Cases from a Community Cancer Center: 1990–2010.

Abstract

Abstract Background: Myelodysplastic syndrome (MDS) has not been well documented or described post breast cancer (BC) treatment. Methods: A cohort of all breast cancer patients from 1989 to 2010 at our institution were followed for incidence of blood disorders of any type by our registry system and by linkage to the Surveillance, Epidemiology and End Results (SEER) registry for our area. All cases of post breast cancer leukemia were reviewed for incidence of MDS from a cohort of 9846 cases diagnosed between 1990 and 2010. Coding of cases was assigned by the SEER registry using ICD-0 codes for type of leukemia from pathology reports. 20 cases of MDS were identified and confirmed using SEER coding for MDS and death certificate review if applicable. Variables of interest included age, race, treatment received, recurrence and treatment for recurrence, time interval from breast cancer diagnosis to leukemia diagnosis and time from leukemia diagnosis to follow up or death. Cytogenetic studies were available on 5 of the 20 patients. Results: Mean age of the patients was 56 years, range 33–79, with 65% < age 65. 90% of the patients were white and 10% Asian. TNM BC stage distribution was stage 0=2, stage I=8, stage II=8, and stage III=2. MDS was diagnosed at a median time post BC diagnosis of 65 months, range 8–205 months including 5 patients treated for recurrence and median 47 months, range 8–205 months excluding patients with recurrence. Nine patients had initial chemotherapy treatment, two without initial adjuvant therapy received chemotherapy for recurrence, and 9 received radiation only. Eight of eleven patients who received chemotherapy were treated with doxorubicin. All eleven received cyclophosphamide. Five of the 20 cases had MDS, not otherwise specified (NOS) (9989), 4 cases had MDSaAML, 3 MDS treatment related (9987), 3 refractory anemia (RA) (9980), 3 refractory anemia with excess blasts (RAEB) (9983), 1 RA with sideroblasts (9982), and 1 MDS with 5q deletion. Three of the five patients with cytogenetics available had chromosome 7 abnormalities and one had 11q21,23. Eleven of the 20 patients (55%) died of MDS or MDSaAML with a mean survival of 17 months, range 0.5-72 months. Six patients were alive at follow up with mean survival 56 months, range 43–89. Two of the surviving patients had stem cell transplants. The remaining three patients died of other causes with mean survival 66 months, range 7–109 months. Mean survival of all patients was 36.26 months, range .53-109 months with a significant difference in survival time between the patients that died of MDS, those alive at follow up and those that died of other causes (F statistic 6.56, p=.008). Discussion: MDS is a significant complication of breast cancer treatment with radiation and/or chemotherapy with a high rate of associated mortality. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-11.