Examination of future malignant tumors after secondary myelofibrosis
A recent study examined the association between patients with secondary myelofibrosis (SMF) and the subsequent development of second primary non-hematologic malignancies (PMS).
A recent study examined the association between patients with secondary myelofibrosis (SMF) and the subsequent development of second primary non-hematologic malignancies (PMS). While PMS is known to occur at a higher rate in patients with myeloproliferative neoplasms (MPN), there is limited information on whether or not it occurs after secondary myelofibrosis.
Polycythemia essential (PV) and essential thrombocythemia (ET) are 2 types of NMP that can progress to post-PV (PPV) and post-ET (PET) myelofibrosis (MF), generally referred to as SMF.
The cumulative incidence over 10 years of non-hematologic PMS in 20,250 patients with PND included in the surveillance, epidemiology and end-results program database was 12.7%, higher than expected in the population. general of the United States.
This study aimed to establish the incidence of PMS, the relationship between PMS and the occurrence of SMF in PV and ET, and to examine the effect of Janus kinase (JAK) inhibitors on the occurrence of PMS. SPM. The researchers included 2233 patients, separated into 2 groups: the MYSEC cohort of 781 patients with SMF and the Pavia cohort of 611 patients with PV and 841 patients with ET.
In the MYSEC cohort, after a median follow-up of 14.8 years from the initial diagnosis of PV or TE, 55 (7%) patients had PMS; 8 had no available date of PMS and were excluded from the time-dependent analysis, 22 (46.8%) had PMS during the ET or PV phase and 25 (53.2%) had PMS after transformation into SMF.
The incidence of PMS after the diagnosis of SMF was 0.98 per 100 patient-years. Adjusting for non-melanoma skin cancer, the incidence of PMS after the diagnosis of SMF increased to 1.56 per 100 patient-years.
When the MYSEC and Pavia cohorts were combined, there was no significant difference in the incidence of PMS between patients whose disease progressed to FMS and those whose disease did not (P = .06). In patients with SMF, treatment with JAK inhibitor has only been associated with recurrence of non-melanoma skin cancer (P = 0.02), which may result from using hydroxyurea JAK inhibitor therapy first or later. Doctors should watch for skin cancers before and during treatment with JAK inhibitor, the researchers wrote.
These findings underscore the need for studies to identify MPN patients at higher risk for PMS, the authors wrote, and that future research should aim to identify patients at higher risk for secondary primary malignancies.
Mora B, Rumi E, Guglielmelli E, et al. Second primary malignant tumors in postpolycythemia vera myelofibrosis and postessential thrombocythemia: a study of 2233 patients [published online June 7, 2019]. Cancer Med. doi: 10.1002 / cam4.2107.