Second malignancies in patients with myeloproliferative neoplasms: a population-based cohort study of 9379 patients

Abstract

To determine the risk of a wide range of second malignancies in patients with myeloproliferative neoplasms (MPNs), we conducted a large population-based study and compared the results to matched controls. From national Swedish registers, 9379 patients with MPNs diagnosed between 1973 and 2009, and 35,682 matched controls were identified as well as information on second malignancies, with follow-up until 2010. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using Cox regression and a flexible parametric model. There was a significantly increased risk of any non-hematologic cancer with HR of 1.6 (95% CI: 1.5-1.7). The HRs for non-melanoma skin cancer was 2.8 (2.4-3.3), kidney cancer 2.8 (2.0-4.0), brain cancer 2.8 (1.9-4.2), endocrine cancers 2.5 (1.6-3.8), malignant melanoma 1.9 (1.4-2.7), pancreas cancer 1.8 (1.2-2.6), lung cancer 1.7 (1.4-2.2), and head and neck cancer 1.7 (1.2-2.6). The HR of second malignancies was similar across all MPN subtypes, sex, and calendar periods of MPN diagnosis. The risk of developing a hematologic malignancy was also significantly increased; the HR for acute myeloid leukemia was 46.0 (32.6-64.9) and for lymphoma 2.6 (2.0-3.3). In conclusion, our study provides robust population-based support of an increased cancer risk in MPN patients.

Figure 1.

Hazard ratio of all second non-hematologic malignancies for patients with myeloproliferative neoplasm (MPN) compared to matched population controls, in relation to time from MPN diagnosis

Figure 2.

Hazard ratio of second non-melanoma skin cancer for patients with myeloproliferative neoplasms (MPN) compared to matched population controls, in relation to time from MPN diagnosis

Figure 3.

Hazard ratio of second acute myeloid leukemia for patients with myeloproliferative neoplasm (MPN) compared to matched population controls, in relation to time from MPN diagnosis

Figure 4.

Cumulative incidences with 95 % confidence intervals, of all non-hematologic malignancies in patients with myeloproliferative neoplasm (MPN) subdivided by sex and age group, compared to matched controls, for the last calendar period, 2002-2009.