There has been a heightened risk of therapy-related myelodysplastic syndrome or acute myeloid leukemia (tMDS/AML) in recent years of cancer treatment, according to a study published in JAMA Oncology.

In this study, researchers analyzed Medicare claims and Surveillance, Epidemiology, and End Results (SEER) Program data from 700,612 patients who had received their first primary solid cancer diagnoses between 2000 and 2013, with 1619 patients developing tMDS/AML. 

Chemotherapy was significantly associated with development of tMDS/AML for 22 of 23 solid cancer types, with relative risks reportedly spanning 1.5- to 10-fold higher, depending on primary cancer type, for patients treated with chemotherapy. Colon cancer was the exception that did not show such an association. Additionally, 73.0% of tMDS/AML cases in the next 5 years are projected to be associated with chemotherapy usage.

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The outlook was poor following a diagnosis of tMDS/AML among patients in this study, with a median overall survival of 7 months, and 78.4% of the patients with tMDS/AML had died. 

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Initial chemotherapy with a treatment known to be leukemogenic increased substantially in prevalence during the study period, from 57% to 81% of initial chemotherapy cases. This was especially true in treatment of gastrointestinal cancers. These trends were due mostly to increased use of platinum-based therapies, which by 2012 to 2013 were included in initial chemotherapy in the majority of cases for several cancer types.

The researchers cautioned that there has been a trend toward increased reliance on leukemogenic chemotherapy agents in recent years, which is resulting in considerable tMDS/AML risk. 


Morton LM, Dores GM, Schonfeld SJ, et al. Association of chemotherapy for solid tumors with development of therapy-related myelodysplastic syndrome or acute myeloid leukemia in the modern era [published online December 20, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.5625