Eur J Haematol. 2021 May 9. doi: 10.1111/ejh.13650. Online ahead of print.
ABSTRACT
OBJECTIVES: The aim of this study was to determine risk factors for development of acute myeloid leukemia/myelodysplastic syndromes (AML/MDS) in patients with multiple myeloma (MM).
METHODS: We identified all patients diagnosed with MM in Sweden from January 1st , 1958 to December 31st , 2011. A total of 26,627 patients were diagnosed with MM with during the study period. Of these, 124 patients (0.5%) developed subsequent AML/MDS. For each patient with MM and a subsequent AML/MDS diagnosis, we randomly selected a matched (age, sex, and date of MM diagnosis) MM patient without a subsequent second malignancy diagnosis.
RESULTS: The cumulative melphalan exposure was significantly higher (OR=2.8, 95% CI 1.7-5.2; p<0.001) among cases (median 988 mg; IQR 644-1,640) compared to controls (median 578 mg; IQR 360-967). Median time to AML/MDS development was 3.8 years (IQR 2.8 – 5.8). Risk of AML/MDS was not statistically altered by M protein isotype, anemia, renal failure, hypercalcemia, lytic bone lesions, or radiation therapy.
CONCLUSION: In this nationwide population-based study, we show that increased cumulative doses of alkylating therapy with melphalan increases the subsequent risk of developing AML/MDS in patients with MM. Given improved survival in MM patients over the last decade future studies will be important to better define long-term risks.
PMID:33966293 | DOI:10.1111/ejh.13650
