Risk Factors Beyond Chemotherapy Exposure for Secondary Myeloid Neoplasms After Hematologic Cancers: A SEER-Based Study

As survival rates for lymphoid malignancies continue to improve, understanding the late effects post-treatment, such as secondary myeloid neoplasms (sMN), is increasingly critical for survivorship. This large-scale population-based (SEER-Medicare) study investigated risk factors and cumulative incidence of sMN in patients with diagnosis of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and multiple myeloma (MM) between 2000 and 2011, with follow-up through 2015. FL patients had a continuous increase in the cumulative incidence in sMN with longer follow-up, while MM patients incidence plateaued after 60 months. Notably, DLBCL patients diagnosed in more recent years (2004-2007 and 2008-2011) had a higher cumulative sMN incidence compared to those diagnosed earlier (2000-2003). In the Medicare population, older age at diagnosis was associated with significant increase in sMN risk in DLBCL and FL patients. Chemotherapy exposure, or granulocyte-colony stimulating factor (G-CSF) exposure significantly increased sMN risk across all three malignancies. Chronic autoimmune conditions increased sMN risk in DLBCL patients. These findings provide crucial insights into sMN risk factors. Chemotherapy exposure is a recognized risk factor, comorbidities such as a history of autoimmunity and G-CSF exposures have been identified as additional mediators of sMN risk in our study.