Routine clinical parameters and laboratory testing predict therapy-related myeloid neoplasms after treatment for breast cancer

Q: What patient group and clinical question does the study address?

The study evaluates patients with breast cancer who develop unexplained cytopenias and are referred for bone marrow biopsy, aiming to predict therapy-related myeloid neoplasms and support biopsy timing decisions.

Q: How were therapy-related myeloid neoplasms diagnosed and how were treatments categorized?

Diagnosis was determined from Memorial Sloan Kettering pathology reports categorized using International Working Group criteria for MDS and AML. BC treatment was grouped into chemotherapy with radiotherapy, only chemotherapy, only radiotherapy, or only surgery.

Q: Which clinical or laboratory factors were associated with a decreased likelihood of therapy-related myeloid neoplasms?

In multivariable analysis, factors included WBC 4–11 K/mcL, ANC ≥1.5 K/mcL, hemoglobin ≥12.2 g/dL, RDW 11.5–14.5%, presence of bone metastasis, and a time from BC diagnosis to BMBx under 15 months.

Sep 24, 2026

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Clinical and laboratory predictors are needed for timing bone marrow biopsy (BMBx) in patients with breast cancer (BC) who develop unexplained cytopenias months to years after completing therapy. This retrospective study used the Memorial Sloan Kettering Cancer Center database to identify BC patients referred for BMBx between 2002 and 2018. Multivariable logistic regression built a predictive model, validated by 5-fold cross-validation (average AUC 0.88). Lower risk was linked to WBC 4–11 K/mcL, ANC ≥1.5 K/mcL, hemoglobin ≥12.2 g/dL, RDW 11.5–14.5%, bone metastasis presence, and time from BC diagnosis to BMBx <15 months.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Abstract

Introduction

Methods

Variables

ARTICLE-Myelodysplastic Syndromes Routine clinical parameters and laboratory testing predict therapy-related myeloid neoplasms after treatment for breast cancer Giulia Petrone,1*° Charles Gaulin,2* Andriy Derkach,3 Ashwin Kishtagari,4 Mark E. Robson,5 Rekha Parameswaran6\# and Eytan M. Stein7\# 1 Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY; 2 Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ; 3 Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY; 4 Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; 5 Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; 6 Division of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY and 7 Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA °Current address: Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA * GP and CG contributed equally as co-ﬁrst authors. \#RP and EMS contributed equally as co-senior authors. Abstract Correspondence: E. M. Stein [steine@mskcc.org](steine@mskcc.org) Received: December 27, 2021. Accepted: June 20, 2022. Prepublished: June 30, 2022. [https://doi.org/10.3324/haematol.2021.280437](https://doi.org/10.3324/haematol.2021.280437) ©2023 Ferrata Storti Foundation Published under a CC BY-NC license We aim to identify predictors of therapy-related myeloid neoplasms (t-MN) in patients with breast cancer (BC) and cytopenias to determine the timing of bone marrow biopsy (BMBx) . Patients with BC and cytopenias who were referred for BMBx between 2002-2018 were identiﬁed using the Memorial Sloan Kettering Cancer Center institutional database. Characteristics associated with the risk of t-MN were evaluated by multivariable logistic regression and included in a predictive model. The average area under the receiver operating characteristic curve (AUC) was estimated by 5-fold cross-validation. Of the 206 BC patients who underwent BMBx included in our study, 107 had t-MN. By multivariable analysis, white blood cell count 4-11 K/mcL, absolute neutrophil count (ANC) ≥1.5 K/mcL, hemoglobin ≥12.2 g/dL, red cell distribution width 11.5-14.5%, the presence of bone metastasis and a time from BC diagnosis to BMBx <15 months signiﬁcantly decreased the likelihood of t-MN. The average AUC was 0.88. We stratiﬁed our cohort by bone metastasis and by ﬁ ndings on peripheral smear. In both the subset without bone metastasis (n=159) and in the cohort with no blasts or dysplastic cells on peripheral smear (n=96) our variables had similar effects on the risk of t-MN. Among the 47 patients with bone metastasis, an ANC ≥1.5 K/mcL was the only variable associated with a decreased risk of t-MN. Our ﬁ ndings show that in patients with BC and unexplained cytopenias, clinical and laboratory parameters can predict t-MN and assist clinicians in determining the timing of a BMBx. Introduction Therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myeloid leukemia (t-AML)– collectively known as therapy-related myeloid neoplasms (tMN) – are rare long-term complications of cytotoxic chemotherapy and radiotherapy for both solid tumors and hematologic malignancies (HM) 1 The incidence of t-MN is higher after exposure to DNA-damaging agents, especially alkylators, topoisomerase II-inhibitors, and radiation, all commonly used for the adjuvant and neo-adjuvant treat- ment of breast cancer (BC) .2,3 t-MN account for an estimated 10% to 20% of all myeloid neoplasms, and are associated with high risk cytogenetic abnormalities, conveying a poorer prognosis than de novo MDS and AML. As overall BC survival improved over the last several decades, the incidence of t-MN has increased.2,4,5 t-MN occur at a rate of 0.6% to 1. 8% after treatment for BC and the frequency increases bet

FAQs

What patient group and clinical question does the study address?

The study evaluates patients with breast cancer who develop unexplained cytopenias and are referred for bone marrow biopsy, aiming to predict therapy-related myeloid neoplasms and support biopsy timing decisions.

How were therapy-related myeloid neoplasms diagnosed and how were treatments categorized?

Diagnosis was determined from Memorial Sloan Kettering pathology reports categorized using International Working Group criteria for MDS and AML. BC treatment was grouped into chemotherapy with radiotherapy, only chemotherapy, only radiotherapy, or only surgery.

Which clinical or laboratory factors were associated with a decreased likelihood of therapy-related myeloid neoplasms?

In multivariable analysis, factors included WBC 4–11 K/mcL, ANC ≥1.5 K/mcL, hemoglobin ≥12.2 g/dL, RDW 11.5–14.5%, presence of bone metastasis, and a time from BC diagnosis to BMBx under 15 months.

Sep 24, 2026

Uploaded by RuangKosong