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Model of Le Deley et al for Predicting Acute Myeloid Leukemia or Myelodysplasia in a Woman Treated for Breast Cancer

Purpose: To identify a woman with breast cancer who is at risk for developing acute myeloid leukemia or myelodysplasaia as a result of the cancer therapy.

Description

Le Deley et al identified risk factors for acute myeloid leukemia (AML) or myelodysplasia developing in women treated for breast cancer. These can help identify women who may require closer monitoring. The authors are from Institut Gustave-Roussy (Villejuif), Paris XIII University, and multiple hospitals in France.


Parameters:

(1) chemotherapeutic regimen

(2) radiation therapy

(3) granulocyte colony stimulating factor (G-CSF)

 

Parameter

Finding

Relative Risk

chemotherapeutic regimen

epipodophyllotoxins with or without anthracycline

39

 

mitoxantrone

16

 

anthracyclines

3

 

other

1

radiation therapy

no

1

 

yes

4

G-CSF

no

1

 

yes

6

 

where:

• The relative risks are for all patients. In addition, relative risks were determined after exclusion of metastatic breast cancer at presentation and/or secondary solid tumor.

• Epipodophyllotoxins were used in only a small number of women. In some of the analysis it was pooled with the mitoxantrone data.

• Mitoxantrone is a topoisomerase-II inhibitor.

• The need for G-CSF reflects greater marrow damage.

 

product of relative risks =

= (relative risk for chemotherapy) * (relative risk for radiation therapy) * (relative risk for GCSF)

 

Interpretation:

• minimum product: 1

• maximum product: > 380

• The higher the cumulative product the greater the risk of the woman developing  AML or myelodysplasia. The risk may be masked if survival is short following diagnosis of the breast cancer.


 


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Specialty

Objective

ICD-10