ADVERTISEMENT
Second Cancers a Cause of Death for Patients With Ph-Negative MPN
Study findings suggest that second cancers (SCs) are a relevant cause of death opposing myeloproliferative neoplasms (MPN) evolution in patients with Philadelphia-negative MPN (Am J Hematol. 2020;95[3]:295-301).
According to lead investigator Monia Marchetti, MD, PhD, Oncology Unit, Cardinal Massaia Hospital, Asti, Italy, and colleagues, 1 in 10 patients with Philadelphia-negative MPN develop a SC.
Thus, using data from an international nested case-control study, Dr Marchetti et al sought to evaluate the survival impact of SC and MPN-specific treatments in 798 patients with SC diagnosed concurrently or after MPN.
After accumulating 2995 person-years (PYs), the investigators established that the mortality rate (MR) since SC diagnosis was 5.9 (5.1-6.9) deaths for every 100 PYs.
Approximately 26% of the patients had a poor prognosis SC (ie, stomach, esophagus, liver, pancreas, lung, ovary, head-and-neck or nervous system, osteosarcomas, multiple myeloma, aggressive lymphoma, acute leukemia), and 65% of these patients died from these causes (MR 11.0/100 PYs).
Alternatively, a MR of 4.6/100 PYs was reported in patients with a non-poor prognosis SC, including 31% who died because of the SC and 15% who died due to MPN evolution.
Death occurring after SC diagnosis was independently prognosticated by patient age >70 years (hazard ratio [HR], 2.68; 95% CI, 1.88-3.81), the SC prognostic group (HR, 2.57; 95% CI, 1.86-3.55), SC relapse (HR, 1.53; 95% CI, 10.6-2.21), MPN evolution (HR, 2.72; 95% CI, 1.84-4.02), anemia at SC diagnosis (HR, 2.32; 95% CI, 1.49-3.59), and exposure to hydroxyurea (HR, 1.89; 95% CI, 1.26-2.85) and to ruxolitinib (HR, 3.63; 95% CI, 1.97-6.71).
Of note, aspirin was protective in patients with non-poor prognosis SCs (HR, 0.60; 95% CI, 0.38-0.95).
“In conclusion, SC is a relevant cause of death competing with MPN evolution,” Dr Marchetti and co-investigators wrote.
“Prospective data are awaited to confirm the role of cytoreductive and anti-platelet drugs in modulating patient survival after the occurrence of a SC,” they concluded.—Hina Porcelli
