AML-194 second hematological malignancies in survivors of breast cancer: an Indian Institutional Analysis

Abstract

Breast cancer survivors are at increased risk of developing second hematological malignancies (SHM). As the survival rates increase in breast cancer patients, SHM have become a cause of concern. Objective: To determine the incidence of various SHM in breast cancer survivors at a large tertiary care center in India. Design, Setting, and Participants: This retrospective study was conducted at the All India Institute of Medical Sciences, New Delhi, India. Women who were diagnosed with first primary breast cancer between 2006 and 2019 at our institute and subsequently developed SHM ≥1 year after primary breast cancer diagnosis were analyzed. Main Outcome Measures: The incidence of various myeloid or lymphoid malignancies developing at least one year after primary breast cancer diagnosis. Results: Between 2006 and 2019, a total of 4,900 patients were diagnosed with female breast cancer and treated with multimodality treatment, including chemotherapy, at our center. Seventy-nine percent (79%) of patients received 3 weekly sequential anthracyclines and taxane, 2% received only anthracyclines, and 19% received only taxane-based chemotherapy. Primary or secondary GCSF prophylaxis was used in 18% of cases. With a median follow-up period of 54 months (4.5 years), 21 (0.43%) patients developed SHM. The median age at diagnosis of SHM was 59 years, and the median interval between breast cancer diagnosis and SHM was 42 months. The most common SHM was acute myeloid leukemia (AML; n=12) followed by non-Hodgkin lymphoma (n=3); 2 cases of myelodysplastic syndrome, 2 cases of acute lymphocytic leukemia, and 1 case each of chronic myeloid leukemia, Hodgkin lymphoma, and multiple myeloma were observed. Conclusions: Of the breast cancer survivors included, 0.43% developed SHM, and AML (0.24%) is the most common. The incidence of secondary AML is probably low from the reported western literature because of not routinely using a dose-dense protocol, infrequent GCSF administration, and one-fifth of patients received non-anthracycline-based treatment protocol in a specific subgroup of breast cancer.