Myeloproliferative Neoplasm Predicts Reduced Solid Tumour Survival

Patients are less likely to survive for 5 years after diagnosis of localised solid tumour if they have a history of myeloproliferative neoplasm

medwireNews: Chronic myeloproliferative neoplasm predicts reduced survival in patients with a new diagnosis of a localised solid tumour, suggest study findings published in The Lancet Haematology.
The 1246 patients with a prior diagnosis of essential thrombocythaemia (ET), polycythaemia vera (PV) or chronic myeloid leukaemia (CML) were 1.21 to 2.28 times more likely to die within 5 years of being diagnosed with their second primary tumour, depending on the time since their initial diagnosis, than their 5155 peers with no such history.

“Although it seems self-evident that cancer patients with two neoplastic diseases would have poorer survival than patients with only one, outlook is generally good in patients with [ET] or [PV], and modern management of [CML] results in many patients achieving remission and long survival”, explain Henrik Frederiksen, from Odense University Hospital in Denmark, and co-authors.

“Hence, these high-prevalence cancer types are of interest to clinicians caring for patients with multiple primary cancers, one of which is a myeloproliferative neoplasm, to understand how prognosis might be affected.”

Five-year survival was 49.8%, 47.9% and 48.0% for patients with ET, PV and CML who were diagnosed with a localised solid tumour, respectively, versus 72.4%, 63.9% and 74.3% in patients with no history of myeloproliferative neoplasm who were matched by localised tumour type, age, gender and year of cancer diagnosis.

The corresponding survival rates for ET, PV and CML patients without comorbidity were 50.7%, 38.8% and 48.3%, respectively, while the rates for their matched patients without myeloproliferative neoplasm or comorbidity were 60.3%, 48.2% and 61.0%.

Of note, the risk of death was increased for patients who were diagnosed with a second primary malignancy within 5 years of their myeloproliferative neoplasm and for those who were diagnosed more than 5 years later.

In patients with prior myeloproliferative neoplasm, the risk of death was “substantially increased” in those with distant metastases versus localised disease, and for those with a high degree of comorbidity versus no comorbidity.

However, among patients with metastatic disease or high comorbidity scores at time of solid tumour diagnosis, prior myeloproliferative neoplasm did not significantly impact their survival.

Robyn Scherber and Ruben Mesa, from the Mayo Clinic in Scottsdale, Arizona, USA, observe in an accompanying comment that the reduced survival of the myeloproliferative neoplasm patients may be associated with a predisposition to thrombosis, bleeding or cytopenia, or with the old age and deconditioning associated with these illnesses.

“More research is needed to investigate the role of cytokine dysfunction in increased tumour progression and deadly secondary infections”, they suggest.

“Ultimately, these possibilities raise the question of how to achieve optimum surveillance and survival once secondary cancers have been detected.”

References

Frederiksen H, Farkas DK, Christiansen CF, et al. Survival of patients with chronic myeloproliferative neoplasms and new primary cancers: a population-based cohort study. Lancet Haematol 2015; Advance online publication 11 June. DOI: http://dx.doi.org/10.1016/S2352-3026(15)00092-7

Scherber R, Mesa RA. Survival and new cancers with myeloproliferative neoplasms. Lancet Haematol 2015; Advance online publication 11 June. DOI: http://dx.doi.org/10.1016/S2352-3026(15)00109-X

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