@article{47838cf302e348d8b255b3d40b7823b7,
title = "Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511)",
abstract = "Purpose: We examined acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) events among 9679 women treated for breast cancer on four adjuvant Alliance for Clinical Trials in Oncology trials with >90 months of follow-up in order to better characterize the risk for AML/MDS in older patients receiving anthracyclines. Methods: We used multivariable Cox regression to examine factors associated with AML/MDS, adjusting for age (≥65 vs. <65 years; separately for ≥70 vs. <70 years), race/ethnicity, insurance, performance status, and anthracycline receipt. We also examined the effect of cyclophosphamide, the interaction of anthracycline and age, and outcomes for those developing AML/MDS. Results: On Cancer and Leukemia Group B (CALGB) 40101, 49907, 9344, and 9741, 7290 received anthracyclines; 15% were in the age ≥65 and 7% were ≥70. Overall, 47 patients developed AML/MDS (30 AML [0.3%], 17 MDS [0.2%]); 83% of events occurred within 5 years of study registration. Among those age ≥65 and ≥70, 0.8 and 1.0% developed AML/MDS (vs. 0.4% for age <65), respectively. In adjusted analyses, older age and anthracycline receipt were significantly associated with AML/MDS (adjusted hazard ratio [HR] for age ≥65 [vs. <65] = 3.13, 95% confidence interval [CI] 1.18–8.33; HR for anthracycline receipt [vs. no anthracycline] = 5.16, 95% CI 1.47–18.19). There was no interaction between age and anthracycline use. Deaths occurred in 70% of those developing AML/MDS. Conclusions: We observed an increased risk for AML/MDS for older patients and those receiving anthracyclines, though these events were rare. Our results help inform discussions surrounding anticipated toxicities of adjuvant chemotherapy in older patients.",
keywords = "Breast cancer, Chemotherapy, Leukemia, Myelodysplastic syndrome, Older patients",
author = "Freedman, {Rachel A.} and Seisler, {D. K.} and Foster, {J. C.} and Sloan, {J. A.} and Lafky, {J. M.} and Kimmick, {G. G.} and A. Hurria and Cohen, {H. J.} and Winer, {E. P.} and Hudis, {C. A.} and Partridge, {A. H.} and Carey, {L. A.} and A. Jatoi and Klepin, {H. D.} and M. Citron and Berry, {D. A.} and Shulman, {L. N.} and Buzdar, {A. U.} and Suman, {V. J.} and Muss, {H. B.}",
note = "Funding Information: Rachel Freeman has received institutional funding from Genentech, Puma, and Eisai. Drew Seisler reports renumeration from Mayo Clinic. Jared Foster declares that he has no conflict of interest. Jeff Sloan declares that he has no conflict of interest. Jacqueline Lafky declares that she has no conflict of interest. Gretchen Kimmick has served on speakers bureaus and has consultant/advisory roles for Pfizer, Astra Zeneca, Novartis, Genomic Health, and Genentech, and has received funding from Wyeth, Astra Zeneca, Glaxo Smith Kline, Novartis, PUMA, Bristol Meyers Squibb, and Bionovo. Arti Hurria has consultant/advisory roles for Boehringer Ingelheim Pharmaceuticals, Carevive, Sanofi, and GTx, Inc, and has received funding from Celegene, Novartis, and GSK. Harvey Cohen declares that he has no conflict of interest. Eric Winer declares that he has no conflict of interest. Clifford Hudis declares that he has no conflict of interest. Ann Partridge declares that she has no conflict of interest. Lisa Carey declares that she has no conflict of interest. Aminah Jatoi declares that he has no conflict of interest. Heidi Klepin declares that she has no conflict of interest. Marc Citron reports speakers bureau roles for Genentech and Pfizer, consultant/advisory roles for Genentech and Pfizer, and funding from Genentech, Pfizer, Celldex, Merck, Puma, and Macrogenics. Donald Berry reports renumeration from Berry Consultants, LLC, a consultant/advisory role for Berry Consultants, LLC, and stock ownership in Berry Consultants, LLC (co-owner). Lawrence Shulman declares that he has no conflict of interest. Aman Buzdar declares that he has no conflict of interest. Vera Suman declares that she has no conflict of interest. Hyman Muss declares that he has no conflict of interest. Funding Information: This study was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), U10CA032291, U10CA047559, U10CA047577, U10CA077597, U10CA077651, U10CA180790, U10CA180791, U10CA180838, U10CA180857, U10CA180867. RAF also receives funding Susan G. Komen (Grant No. CCR14298143) and American Cancer Society (Grant No. 125912-MRSG-14-240-01-CPPB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2016, Springer Science+Business Media New York.",
year = "2017",
month = jan,
day = "1",
doi = "10.1007/s10549-016-4051-1",
language = "English (US)",
volume = "161",
pages = "363--373",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",
number = "2",
}