Characteristics and outcomes of patients with multiple myeloma who develop therapy-related myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia

Naveen Pemmaraju, Dhaval Shah, Hagop Kantarjian, Robert Z. Orlowski, Graciela M. Nogueras González, Veera Baladandayuthapani, Nitin Jain, Verena Wagner, Guillermo Garcia-Manero, Jatin Shah, Farhad Ravandi, Sherry Pierce, Koichi Takahashi, Naval Daver, Aziz Nazha, Srdan Verstovsek, Elias Jabbour, Marcos De Lima, Richard Champlin, Jorge CortesMuzaffar H. Qazilbash

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Background Patients with multiple myeloma (MM) have had significant improvements in outcomes. An increased risk of therapy-related myeloid neoplasms (t-MNs) has also developed. Little is known about the characteristics and outcomes of these patients. Patients and Methods Patients with MM treated at our institution from 1993 to 2011 were reviewed. Forty-seven patients were diagnosed with t-MN. Our primary objective was to evaluate the interval to t-MN, response to treatment, and overall survival (OS). Results The median patient age at the MM diagnosis was 65 years. Of the 47 patients, 32 (68.0%) initially received conventional chemotherapeutic agents, 7 (14.9%), novel agents (eg, lenalidomide, thalidomide, bortezomib), and 8 (17.0%), a combination. Twenty patients (42.6%) underwent high-dose chemotherapy and autologous hematopoietic stem cell transplantation. The median interval from the MM diagnosis to t-MN was 7 years (95% CI, 5.0-28.0). Of the 47 patients, 33 (70.2%) developed therapy-related myelodysplastic syndrome (t-MDS), 11 (23.4%) acute myeloid leukemia (t-AML), and 3 (6.4%) chronic myelomonocytic leukemia (t-CMML). The median age at the t-MN diagnosis was 65 years. Of the 47 patients, 26 (78.8%) with t-MDS, 9 (81.8%) with t-AML, and 1 (33.3%) with t-CMML had complex/high-risk cytogenetics. The median OS for all 47 patients after the t-MN diagnosis was 6.3 months (95% CI, 4.0-8.7). Conclusion The development of t-MN in patients with MM is associated with poor outcomes. These patients, in general, have complex cytogenetic abnormalities and short complete remission and OS times. A better understanding of the disease biology and novel therapeutic approaches are warranted.

Original languageEnglish (US)
Pages (from-to)110-114
Number of pages5
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Keywords

  • Novel therapeutic agents
  • Overall survival
  • Second primary neoplasm
  • Therapy-related myeloid neoplasm

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Pemmaraju, N., Shah, D., Kantarjian, H., Orlowski, R. Z., Nogueras González, G. M., Baladandayuthapani, V., Jain, N., Wagner, V., Garcia-Manero, G., Shah, J., Ravandi, F., Pierce, S., Takahashi, K., Daver, N., Nazha, A., Verstovsek, S., Jabbour, E., De Lima, M., Champlin, R., ... Qazilbash, M. H. (2015). Characteristics and outcomes of patients with multiple myeloma who develop therapy-related myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia. Clinical Lymphoma, Myeloma and Leukemia, 15(2), 110-114. https://doi.org/10.1016/j.clml.2014.07.001