| Source: |
Marchetti, M, Ghirardi, A, Masciulli, A, Carobbio, A, Palandri, F, Vianelli, N, Rossi, E, Betti, S, Di Veroli, A, Iurlo, A, Cattaneo, D, Finazzi, G, Bonifacio, M, Scaffidi, L, Patriarca, A, Rumi, E, Casetti, I C, Stephenson, C, Guglielmelli, P, Elli, E M, Palova, M, Rapezzi, D, Erez, D, Gomez, M, Wille, K, Perez-Encinas, M, Lunghi, F, Angona, A, Fox, M L, Beggiato, E, Benevolo, G, Carli, G, Cacciola, R, McMullin, M F, Tieghi, A, Recasens, V, Isfort, S, Pane, F, De Stefano, V, Griesshammer, M, Alvarez-Larran, A, Vannucchi, A M, Rambaldi, A & Barbui, T 2019, 'Second cancers .... |
| Description: |
One out of ten patients with Philadelphia-negative myeloproliferative neoplasms (MPN) develop a second cancer (SC): in such patients we aimed at assessing the survival impact of SC itself and of MPN-specific therapies. Data were therefore extracted from an international nested case-control study, recruiting 798 patients with SC diagnosed concurrently or after the MPN. Overall, 2995 person-years (PYs) were accumulated and mortality rate (MR) since SC diagnosis was 5.9 (5.1-6.9) deaths for every 100 PYs. A “poor prognosis” SC (stomach, esophagus, liver, pancreas, lung, ovary, head-and-neck or nervous system, osteosarcomas, multiple myeloma, aggressive lymphoma, acute leukemia) was reported in 26.3% of the patients and was the cause of death in 65% of them (MR 11.0/100 PYs). In contrast, patients with a “non-poor prognosis” SC (NPPSC) incurred a MR of 4.6/100 PYs: 31% of the deaths were attributed to SC and 15% to MPN evolution. At multivariable analysis, death after SC diagnosis was independently predicted (HR and 95% CI) by patient age greater than 70 years (2.68; 1.88-3.81), the SC prognostic group (2.57; 1.86-3.55), SC relapse (1.53; 10.6-2.21), MPN evolution (2.72; 1.84-4.02), anemia at SC diagnosis (2.32; 1.49-3.59), exposure to hydroxyurea (1.89; 1.26-2.85) and to ruxolitinib (3.63; 1.97-6.71). Aspirin was protective for patients with a NPPSC (0.60; 0.38-0.95). In conclusion, SC is a relevant cause of death competing with MPN evolution. Prospective data are awaited to confirm the role of cytoreductive and anti-platelet drugs in modulating patient survival after the occurrence of a SC. |