Risk of Acute Leukemia Following Epirubicin-Based Adjuvant Chemotherapy: A Report From the National Cancer Institute of Canada Clinical Trials Group
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- Michael Crump
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
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- Dongsheng Tu
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
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- Lois Shepherd
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
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- Mark Levine
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
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- Vivien Bramwell
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
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- Kathleen Pritchard
- From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
抄録
<jats:p> Purpose: Cyclophosphamide, epirubicin, and fluorouracil (CEF), compared with classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. has lead to an improvement in relapse-free and overall survival in premenopausal women with node-positive breast cancer. We undertook this analysis to more accurately define the estimate of risk of secondary acute leukemia (sAL) following epirubicin-containing chemotherapy regimens. </jats:p><jats:p> Patients and Methods: We assessed the conditional probability of sAL among 1,545 women who received adjuvant (n = 1,477) or neoadjuvant (n = 68) chemotherapy in four National Cancer Institute of Canada Clinical Trials Group trials from 1990 to 1999. The risks associated with epirubicin-containing regimens (CEF or epirubicin and cyclophosphamide [EC]) and other regimens (doxorubicin and cyclophosphamide [AC] or CMF) were determined. </jats:p><jats:p> Results: A total of 10 cases of sAL were observed (eight acute myelogeneous leukemia, two acute lymphoblastic leukemia): seven among women treated with CEF, two who had received AC, and one following CMF. Using competing risk statistics, the conditional probability of sAL was 1.7% (95% confidence interval [CI], 0.5 to 3.6) among 539 women treated with CEF chemotherapy at a follow-up of 8 years, 0.4% (95% CI, 0% to 1.3%) among the 678 who received CMF, and 1.3% (95% CI, 0% to 4.7%) among the 231 treated with AC. The conditional probability of death from breast cancer at 8 years for the entire group of women treated with epirubicin-containing regimens in all four trials was approximately 34.9%. </jats:p><jats:p> Conclusion: CEF chemotherapy for breast cancer carries a small increased risk of sAL compared with CMF. These estimates of acute leukemia risk are important in discussing treatment with women, especially patients with a lower risk of death from breast cancer, such as those with node-negative breast cancer. </jats:p>
収録刊行物
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- Journal of Clinical Oncology
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Journal of Clinical Oncology 21 (16), 3066-3071, 2003-08-15
American Society of Clinical Oncology (ASCO)
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詳細情報 詳細情報について
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- CRID
- 1360011145603275008
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- NII論文ID
- 30022789142
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- ISSN
- 15277755
- 0732183X
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