Myeloid Neoplasms appearing after Cytotoxic Therapy in Patients with Nasopharyngeal Carcinoma: Experience at a Single Institute

Abstract

Abstract Objectives Myeloid neoplasms post cytotoxic therapy (MN-pCT) is a specific hematological disease arising after chemoradiotherapy (CRT) for a variety of primary unrelated malignancies or autoimmune diseases. MN-pCT after treatment of nasopharyngeal carcinoma (NPC) is rarely reported. Here, we aimed to determine the prevalence and risks of MN-pCT among individuals who have previously undergone treatment for NPC. Methods Data were retrieved from the cancer registry database of the study hospital. History of NPC patients who had undergone CRT during the period of 2006 to 2021 was reviewed. MN-pCT after NPC treatment were identified among them. In addition, a group of patients with de novo myeloid neoplasms matched with the gender and age of MN-pCT subjects were collected for comparison. Results A total of 9 patients with MN-pCT related to NPC therapy were identified. Six were myelodysplastic syndrome-post cytotoxic therapy (MDS-pCT) and 3 were acute myeloid leukemia-post cytotoxic therapy (AML-pCT). All had undergone high-dose radiotherapy and alkylating agents. The median time from NPC therapy to the diagnosis of MN-pCT was 7 years. MN-pCT patients presented with anemia, neutropenia, recurrent infection, and fatigue. All NPC related MN-pCT died when this study ended with a median overall survival of only 2 months. There were significant differences in survival between patients with MN-pCT and patients with de novo AML / MDS (P = 0.0001). Conclusion Individuals who have undergone intensive treatment for NPC display a propensity to develop MN-pCT. Despite the relatively low incidence of MN-pCT, the associated prognosis was dismal. This study emphasizes the importance of heightened vigilance when managing NPC survivors who have received intensive treatment even beyond the conventional 5-year surveillance period.