Second cancers (SCs) pose a significant mortality risk among patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), according to an article published in the American Journal of Hematology.
MPNs, chronic bone marrow disorders associated with transformation into myelofibrosis, myelodysplasia, and acute myeloid leukemia, are also associated with SCs. Whether SCs affect prognosis in this setting was, however, previously unknown.
For this analysis of a previous nested case control study, researchers evaluated data from patients with an MPN to determine both the prognosis of those with an SC, and whether cytoreductive or antiplatelet therapies affect outcomes among these patients.
Among 798 patients included in this analysis, the mean age was 63.4 years, 419 (52.5%) were male, and 603 (75.6%) had a JAK2V617mutation. Most (587; 73.6%) patients had an SC classified as non-poor prognosis, the most common of which were non-melanoma skin cancer (20.6%), prostate/urinary tract cancer (19.2%), and breast cancer (12.7%). The remaining 209 (26.2%) patients had a poor prognosis cancer, including respiratory tract trachea bronchus lung cancer (8.6%), ovarian/uterine cancer (3.6%), and upper gastrointestinal tract cancer (3.4%).
Patients with a non-poor prognosis SC had a mortality rate of 4.6 per 100 person-years, of which 31% were related to the SC and 15% of which were linked with MPN evolution. Among those with a poor prognosis SC, however, the mortality rate per 100 person-years was 11, and the SC was linked with 65% of deaths.
Age greater than 70 years at SC diagnosis (hazard ratio [HR], 2.68), SC prognostic group (HR, 2.57), SC relapse (HR, 1.53), MPN evolution (HR, 2.72), and anemia at diagnosis (HR, 2.32) were each linked with mortality on multivariate analysis.
While exposure to hydroxyurea (HR, 1.89) or ruxolitinib (HR, 3.63) were associated with worse survival outcomes, aspirin appeared to have a protective effect in the non-poor prognosis group (HR, 0.6).
“The impact of previous and/or ongoing exposure to cytoreductive and antiplatelet drugs in patients harboring a SC needs to be confirmed by prospective studies,” the authors wrote.
Marchetti M, Ghirardi A, Masciulli A, et al. Second cancers in MPN: survival analysis from an international study. Am J Hematol. 2020;95(3):295-301.