Bjorkholm et al evaluated the impact of therapy on the development of myelodysplasia or acute myeloid leukemia in a patient with a myeloproliferative disorder (polycythemia vera, essential thrombocythemia, primary myelofibrosis, etc). The authors are from Karolinska University Hospital, the Swedish Chronic Myeloproliferative Neoplasm Study Group and the National Cancer Institute (NIH).
Patient selection: myeloproliferative disorder
Outcome: development of myelodysplasia (MDS) and/or acute myeloid leukemia (AML)
Risk factors for outcome:
(1) cumulative dose of P32 > 1,000 MBq (megaBecquerel)
(2) cumulative dose of alkylating agents > 1 gram
(3) cytoreductive therapy with 2 or more different agents (hydroxyurea, P32, alkylating agents)
Therapy with hydroxyurea alone was not associated with an increase risk for MDS or AML.
The risk of a patient with a myeloproliferative disorder developing MDS or AML is increased, even without therapy-effects. A quarter of patients with a myeloproliferative disorder who develop MDS or AML have not been treated with any of the above agents.
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