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Risk for Treatment-related Leukemia after Chemotherapy for Childhood Cancer has Increased Over Last 45 years

, by DCEG Staff

Close up of chemotherapy IV drip in a hospital setting. Chemotherapy for childhood cancer associated with elevated risk of leukemia.

Risk of therapy-related myelodysplastic syndrome and acute myeloid leukemia (tMDS/AML) after initial chemotherapy for childhood cancer has significantly increased between 1975 and 2015, according to a new analysis by Pragati Advani, Ph.D., and colleagues. Their findings are the first comprehensive assessment of tMDS/AML risk after chemotherapy for childhood cancer in the modern treatment era and were published July 24, 2019, in the journal Leukemia.

Clinical approaches to treat childhood cancer have advanced in recent years, with accompanying improvements in prognosis that have led to more research on the long-term health of childhood cancer survivors. Utilizing data first from nine registries in the Surveillance, Epidemiology, and End Results (SEER) program, the researchers showed that the risk for tAML after initial chemotherapy for childhood cancer has increased for patients treated more recently. In light of these increases, the researchers then used an expanded set of 17 registries to comprehensively investigate tMDS/AML risk during 2000-2015, including over 36,000 children. tMDS/AML occurrence was rare but occurred 80-fold more often than expected overall, with elevated risks observed after initial chemotherapy for nearly all types of childhood cancer. Most tMDS/AML cases occurred within 5 years of childhood cancer diagnosis.

The authors note: “Although tMDS/AML is rare, the poor prognosis underscores the importance of counseling patients and their families regarding the risks and benefits of specific treatments. Future research should be directed toward more precisely identifying susceptible individuals.”


Advani P, et al. Risk of therapy-related myelodysplastic syndrome/acute myeloid leukemia after childhood cancer: a population-based study. Leukemia. July 24, 2019. DOI: 10.1038/s41375-019-0520-y [Epub ahead of print]

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