Therapy-related myeloid neoplasms in lymphoma survivors: Reducing risks

Best Pract Res Clin Haematol. 2019 Mar;32(1):47-53. doi: 10.1016/j.beha.2019.02.008. Epub 2019 Feb 16.

Abstract

Treatment for Hodgkin (HL) and non-Hodgkin's lymphoma (NHL) has changed dramatically in the last fifty years. While there are increasing numbers of long-term survivors, there has been increasing recognition of the long-term toxicities of treatments, particularly therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/AML). The survival for t-MDS/AML is extremely poor. Multiple heterogeneous retrospective studies have reported risk factors for the development of t-MDS/AML. Chemotherapy and radiation therapy have been most closely examined as possible t-MDS/AML risk factors. In this paper, we will review the risks of t-MDS/AML for HL and NHL patients as reported in the literature and assess for any changes over time. In HL patients, the incidence of t-MDS/AML has decreased with a reduction in alkylating agents. In indolent NHL patients, we anticipate decreased incidence of t-MDS/AML as targeted therapies begin to replace cytotoxic chemotherapy.

Keywords: Hodgkin lymphoma; Lymphoma; Non-Hodgkin lymphoma; Secondary leukemia; Therapy-related acute myeloid leukemia; Therapy-related myelodysplastic syndrome.

Publication types

  • Review

MeSH terms

  • Alkylating Agents / adverse effects*
  • Alkylating Agents / therapeutic use
  • Hematologic Neoplasms* / chemically induced
  • Hematologic Neoplasms* / mortality
  • Hematologic Neoplasms* / therapy
  • Humans
  • Incidence
  • Lymphoma, Non-Hodgkin* / drug therapy
  • Lymphoma, Non-Hodgkin* / mortality
  • Myeloproliferative Disorders* / chemically induced
  • Myeloproliferative Disorders* / mortality
  • Myeloproliferative Disorders* / therapy
  • Neoplasms, Second Primary* / mortality
  • Neoplasms, Second Primary* / therapy
  • Survivors

Substances

  • Alkylating Agents