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Letters to the Editor
Second primary malignancies in chronic myeloid leukemia patients Access this article online Website: www.cancerjournal.net
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Sir, Second primary malignancy (SPM) in patients with hematological malignancies is a growing issue. Previous studies have conflicting results, and it was demonstrated that SPMs were not more frequent in chronic myeloid leukemia (CML) patients when compared to normal population in the tyrosine kinase inhibitor (TKI) era;[1] whereas, a slightly higher incidence of SPMs in CML patients treated with TKI was observed as well.[2,3] In addition to that, it was shown that survival rates in chronic phase CML (CML‑CP) patients in all age groups were similar to that of general population in the era of TKIs.[4] We read with interest the article by Kaygusuz‑Atagunduz et al.,[5] in which the authors described a female CML‑CP patient who was treated with imatinib for approximately 2 years when she developed breast cancer (BC). CML‑CP patients live longer (and get older) than before in the TKI era,[4] so this can be an explanation of the generation of SPMs. BC is most frequent between ages 55 and 64 years, and the presented case developed BC at the age of 48.[5] She did not have any known traditional BC risk factors, so the underlying CML together with TKI treatment might play a causative role in SPM generation. Although there are CML patients who developed SPMs after a short period of TKI use (i. e., less than a year),[2,3] the median TKI exposure were 51 months[2] and 3.7 years,[3] and SPM was developed after a relatively short period of TKI administration (22 months) in the presented case.[5] In the Czech cohort, consistent with the normal population, women most commonly developed BC.[2] The increased risk of developing a SPM reached statistical significance for females in the Swedish cohort, and when compared to the normal control population, CML patients were at a 50% increased risk of developing a SPM.[3] The authors stated that similar standardized incidence ratio before and after the 2nd year following the diagnosis of CML might indicate that these findings are linked to the CML disease itself, rather than to the TKI treatment.
Journal of Cancer Research and Therapeutics - ??? - Volume ?? - Issue ?
Although imatinib may play a role in the SPM formation as proposed by Kaygusuz‑Atagunduz and colleagues,[5] an association between this agent and second cancer risk in CML needs to be further investigated. Kaygusuz‑Atagunduz et al., thought that the coincidence of CML and BC cannot solely be explained just by chance; however, the issue of SPM in CML is really complex. If there is any true increase in the incidence, there might be many factors contributing to this phenomenon, including other treatments, immunodeficiency, lifestyle choices, aging, and genetic predisposition. Because of the improved survival of CML patients in the TKI era, and as the authors draw an attention to the SPM generation among this patient cohort, CML caring physicians should be aware of signs and symptoms of other malignancies in this patient population, and age‑appropriate cancer screening should play a significant role in the care of the patient with CML. Tugce Caliskan1, Ahmet Emre Eskazan1,2 1 Department of Internal Medicine, 2Division of Hematology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
For correspondence: Dr. Ahmet Emre Eskazan, Department of Internal Medicine, Division of Hematology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey. E‑mail:
[email protected]
REFERENCES 1. Verma D, Kantarjian H, Strom SS, Rios MB, Jabbour E, Quintas‑Cardama A, et al. Malignancies occurring during therapy with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) and other hematologic malignancies. Blood 2011;118:4353‑8. 2. Voglova J, Muzik J, Faber E, Zackova D, Klamova H, Steinerova K, et al. Incidence of second malignancies during treatment of chronic myeloid leukemia with tyrosine kinase inhibitors in the Czech Republic and Slovakia. Neoplasma 2011;58:256‑62. 3. Gunnarsson N, Leif S, Höglund M, Sandin F, Björkholm M, Dreimane A, et al. Second malignancies following treatment of chronic myeloid leukemia in the tyrosine kinase inhibitor era. Blood 2014;124:154. 4. Sasaki K, Strom SS, O’Brien S, Jabbour E, Ravandi F, Konopleva M, et al. Chronic myeloid leukemia in chronic phase: Survival in the era of tyrosine kinase inhibitors is similar to that of the general population in all age groups. Blood 2014;124:1801. 5. Kaygusuz‑Atagunduz I, Toptas T, Yumuk F, Firatli‑Tuglular T, Bayik M. Newly diagnosed breast cancer in a patient receiving imatinib mesylate. J Cancer Res Ther 2014;10:1107‑8.
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