Myeloid neoplasms post-cytotoxic treatment (MN-pCTs) represent an important group of
myeloid malignancies, especially in the elderly (10-20%), with a progressively growing
incidence (1). However, data are scarce, emphasizing the need for further research in this
field. This rising number of new MN-pCT cases might be explained by greater life expectancy,
as well as by an increase in the number of primary cancer survivors. The increased proportion
of patients surviving primary malignancy can be attributed to improved access to
chemotherapeutic drugs, such as the ability to treat elderly patients who previously received
only best supportive care. Furthermore, MN-pCT patients have a worse overall prognosis than
their main counterparts. High-risk genetic anomalies, such as TP53 mutations, are much more
common in MN-pCT patients, reducing overall survival rates across all myeloid neoplasm
categories (47).
Most MN-pCT data currently available comes from retrospective studies directly identifying
individuals who have developed MN-pCT. There are mainly characterization studies aiming at
analysing the type of primary cancer and oncologic therapies received. The goal of this study
is to investigate MN-pCT patients using an inverted strategy, which involves first identifying
patients who had cytotoxic therapy for a primary cancer and then determining the risk of
developing MN-pCT. This study is based on a Lausanne University Hospital (CHUV) cancers
database, from which two cohorts were formed. The general cohort (n = 64) consists of all
MN-pCT patients, including those who were not treated for initial cancer at CHUV, and is used
for general description. The CHUV universe cohort (n = 21), made up of MN-pCT patients who
were treated at CHUV for their primary malignancy, was utilized for risk analysis.
First, we aimed to describe the general cohort exploring parameters such as age at the first
chemotherapy, age at onset, primary malignancies, MN-pCT types, as well as cytogenetic and
mutation profiles. Overall survival and survival in relation to prognosis factors such as
karyotype, MN-pCT types and risk groups were also characterized. Next, we assessed the
risk of developing MN-pCTs depending on the type of chemotherapeutic agent received within
the CHUV universe cohort. The risk estimation analysis focused on patients who were treated
for their primary malignancy at CHUV, due to statistical limitations inherent in risk estimate.
Even though most of the patients received medication combinations, this study was conducted
independently for each chemotherapeutic class. Our results show that individuals treated for
primary malignancy with anthracycline (antibiotics), or nitrogen mustards (alkylating agents)
treatments are significantly linked with an increased likelihood of developing MN-pCTs.
Our findings confirm the overall poor outcome associated with MN-pCT treatment and bring
up new insights on the risk and the epidemiology of the disease among the Swiss population.
However, because this is an uncommon condition, only a limited number of individuals were
identified within the CHUV-based cohort, which can only pave the way for larger-scale
research including patients from throughout the country.