Therapy-Related-Myeloid-Neoplasm-Risk score (TMNRS): a convenient score for tMN risk assessment in adult cancer patients

Background A prediction model for estimating risk of therapy-related myeloid neoplasms (tMN), a late effect with a high mortality after chemotherapy and/or radiation, is currently unavailable. Ability to predict risk at initial cancer presentation can be key for early detection and risk mitigation. Methods Using SEER-Medicare linked database, 970,390 adults diagnosed with first primary cancer from 2000-2011 (with follow-up through 2015) were selected. The sample was divided into training (n = 582,234) and validation cohorts (n = 388,156). Various tMN risk factors were utilized for the development of tMN prediction model: The Therapy-Related Myeloid Neoplasm Risk Score (TMNRS). TMNRS was created as a simple arithmetic sum of independent predictors of tMN weighted according to the adjusted hazard ratio from the Cox proportional hazards analysis. Results In addition to the known risk factors of chemotherapy and radiation exposure, history of autoimmune disease and G-CSF exposure emerged as consistent predictors of tMN after each of the five cancers in the study. Cancer survivors were categorized into distinct risk groups with variable risk of tMN. Conclusion TMNRS provides a simple and convenient office-based mechanism to identify solid cancer patients at variable risks of tMN development. This risk assessment tool provides preliminary insights that may contribute to future research on the management of patients, particularly those receiving adjuvant therapies. Further investigation is required to fully evaluate its clinical utility and potential effects on patient care.