Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone

V. Martinelli, E. Cocco, R. Capra, G. Salemi, P. Gallo, M. Capobianco, I. Pesci, A. Ghezzi, C. Pozzilli, A. Lugaresi, P. Bellantonio, M. P. Amato, L. M. Grimaldi, M. Trojano, G. L. Mancardi, R. Bergamaschi, C. Gasperini, M. Rodegher, L. Straffi, M. PonzioG. Comi

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. Methods: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. Results: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean±SD) was 49±29 months (range 12-140 months).Weobserved 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m2, p=0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%. Conclusions: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML.

Original languageEnglish
Pages (from-to)1887-1895
Number of pages9
JournalNeurology
Volume77
Issue number21
DOIs
Publication statusPublished - Nov 22 2011

Fingerprint

Mitoxantrone
Acute Myeloid Leukemia
Multiple Sclerosis
Therapeutics
Mortality
Hospital Records
Incidence
Early Diagnosis
Cohort Studies
Retrospective Studies
Demography
Confidence Intervals
Delivery of Health Care

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone. / Martinelli, V.; Cocco, E.; Capra, R.; Salemi, G.; Gallo, P.; Capobianco, M.; Pesci, I.; Ghezzi, A.; Pozzilli, C.; Lugaresi, A.; Bellantonio, P.; Amato, M. P.; Grimaldi, L. M.; Trojano, M.; Mancardi, G. L.; Bergamaschi, R.; Gasperini, C.; Rodegher, M.; Straffi, L.; Ponzio, M.; Comi, G.

In: Neurology, Vol. 77, No. 21, 22.11.2011, p. 1887-1895.

Research output: Contribution to journalArticle

Martinelli, V, Cocco, E, Capra, R, Salemi, G, Gallo, P, Capobianco, M, Pesci, I, Ghezzi, A, Pozzilli, C, Lugaresi, A, Bellantonio, P, Amato, MP, Grimaldi, LM, Trojano, M, Mancardi, GL, Bergamaschi, R, Gasperini, C, Rodegher, M, Straffi, L, Ponzio, M & Comi, G 2011, 'Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone', Neurology, vol. 77, no. 21, pp. 1887-1895. https://doi.org/10.1212/WNL.0b013e318238ee00
Martinelli, V. ; Cocco, E. ; Capra, R. ; Salemi, G. ; Gallo, P. ; Capobianco, M. ; Pesci, I. ; Ghezzi, A. ; Pozzilli, C. ; Lugaresi, A. ; Bellantonio, P. ; Amato, M. P. ; Grimaldi, L. M. ; Trojano, M. ; Mancardi, G. L. ; Bergamaschi, R. ; Gasperini, C. ; Rodegher, M. ; Straffi, L. ; Ponzio, M. ; Comi, G. / Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone. In: Neurology. 2011 ; Vol. 77, No. 21. pp. 1887-1895.
@article{9471ec88a3e243a09134f4c356097150,
title = "Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone",
abstract = "Objectives: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. Methods: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. Results: Data were available for 3,220 patients (63{\%} women) from 40 Italian centers. Follow-up (mean±SD) was 49±29 months (range 12-140 months).Weobserved 30 cases of AML (incidence 0.93{\%} [95{\%} confidence interval 0.60{\%}-1.26{\%}]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m2, p=0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27{\%}) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37{\%}. Conclusions: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML.",
author = "V. Martinelli and E. Cocco and R. Capra and G. Salemi and P. Gallo and M. Capobianco and I. Pesci and A. Ghezzi and C. Pozzilli and A. Lugaresi and P. Bellantonio and Amato, {M. P.} and Grimaldi, {L. M.} and M. Trojano and Mancardi, {G. L.} and R. Bergamaschi and C. Gasperini and M. Rodegher and L. Straffi and M. Ponzio and G. Comi",
year = "2011",
month = "11",
day = "22",
doi = "10.1212/WNL.0b013e318238ee00",
language = "English",
volume = "77",
pages = "1887--1895",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "21",

}

TY - JOUR

T1 - Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone

AU - Martinelli, V.

AU - Cocco, E.

AU - Capra, R.

AU - Salemi, G.

AU - Gallo, P.

AU - Capobianco, M.

AU - Pesci, I.

AU - Ghezzi, A.

AU - Pozzilli, C.

AU - Lugaresi, A.

AU - Bellantonio, P.

AU - Amato, M. P.

AU - Grimaldi, L. M.

AU - Trojano, M.

AU - Mancardi, G. L.

AU - Bergamaschi, R.

AU - Gasperini, C.

AU - Rodegher, M.

AU - Straffi, L.

AU - Ponzio, M.

AU - Comi, G.

PY - 2011/11/22

Y1 - 2011/11/22

N2 - Objectives: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. Methods: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. Results: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean±SD) was 49±29 months (range 12-140 months).Weobserved 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m2, p=0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%. Conclusions: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML.

AB - Objectives: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. Methods: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. Results: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean±SD) was 49±29 months (range 12-140 months).Weobserved 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m2, p=0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%. Conclusions: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML.

UR - http://www.scopus.com/inward/record.url?scp=82955225355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=82955225355&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e318238ee00

DO - 10.1212/WNL.0b013e318238ee00

M3 - Article

C2 - 22076543

AN - SCOPUS:82955225355

VL - 77

SP - 1887

EP - 1895

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 21

ER -